Abstract:
OBJECTIVES:Impact assessment of drug benefits policies is a growing field of research that is increasingly relevant to health care planning for older people. Some cost-containment policies are thought to increase noncompliance. This paper examines mechanisms that can produce spurious reductions in drug utilization measures after drug policy changes when relying on pharmacy dispensing data. Reference pricing, a copayment for expensive medications above a fixed limit, for angiotensin-converting enzyme(ACE) inhibitors in older British Columbia residents, is used as a case example. DESIGN:Time series of 36 months of individual claims data. Longitudinal data analysis, adjusting for autoregressive data. SETTING:Pharmacare, the drug benefits program covering all patients aged 65 and older in the province of British Columbia, Canada. PARTICIPANTS:All noninstitutionalized Pharmacare beneficiaries aged 65 and older who used ACE inhibitors between 1995 and 1997 (N = 119,074). INTERVENTION:The introduction of reference drug pricing for ACE inhibitors for patients aged 65 and older. MEASUREMENTS:Timing and quantity of drug use from a claims database. RESULTS:We observed a transitional sharp decline of 110% t a standard error of 30% (P = .02) in the overall utilization rate of all ACE inhibitors after the policy implementation; five months later, utilization rates had increased, but remained under the predicted prepolicy trend. Coinciding with the sharp decrease, we observed a reduction in prescription duration by 31% in patients switching to no-cost drugs. This reduction may be attributed to increased monitoring for intolerance or treatment failure in switchers, which in turn led to a spurious reduction in total drug utilization. We ruled out the extension of medication use over the prescribed duration through reduced daily doses (prescription stretching) by a quantity-adjusted analysis of prescription duration. CONCLUSION:The analysis of prescription duration after drug policy interventions may provide alternative explanations to apparent short-term reductions in drug utilization and adds important insights to time trend analyses of drug utilization data in the evaluation of drug benefit policy changes.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Schneeweiss S,Maclure M,Soumerai SBdoi
10.1046/j.1532-5415.2002.50120.xsubject
Has Abstractpub_date
2002-03-01 00:00:00pages
521-5issue
3eissn
0002-8614issn
1532-5415pii
50120journal_volume
50pub_type
杂志文章abstract::In 1976, 130 patients aged 70 or older were admitted to the Coronary Care Unit (CCU) at Toronto Western Hospital. Arrhythmias were noted in all but 24 percent. Digoxin was given to 53 patients, lidocaine to 24, propranolol to 28, and quinidine to 11. In 2 patients, cardioversion by direct current was required for supr...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1979.tb06032.x
更新日期:1979-05-01 00:00:00
abstract::Circadian changes of the blood pressure and heart rate in elderly normotensive bedridden patients with severe dementia of the Alzheimer type (group D) were compared with those in elderly normotensive bedridden patients without dementia (group R), normotensive subjects with normal daily activity (group N), and hyperten...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1990.tb04418.x
更新日期:1990-09-01 00:00:00
abstract:OBJECTIVE:To compare characteristics, healthcare use, and costs of care of veterans in the rapidly expanding Veterans Health Administration (VHA) medical foster home (MFH) with those of three other VHA long-term care (LTC) programs. DESIGN:Descriptive, unmatched study. SETTING:VHA MFHs, home-based primary care (HBPC)...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.14517
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVES:To determine the prevalence and predictors of adverse postoperative outcomes in older surgical patients undergoing noncardiac surgery. DESIGN:Prospective cohort study of consecutive patients undergoing noncardiac surgery in 1997. SETTING:A medical school-affiliated teaching community hospital. PARTICIPANT...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2001.49212.x
更新日期:2001-08-01 00:00:00
abstract:OBJECTIVES:To compare endothelium-dependent vasomotor response in healthy younger and older subjects without classic cardiovascular risk factors, with high and normal fasting homocysteine (tHcy) levels. DESIGN:We compared endothelium-dependent vasodilatation, using ultrasound, in healthy younger (aged 18-40) and older...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2002.50255.x
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVES:To determine whether the occurrence of depression predicts physical disability in older people. DESIGN:A longitudinal epidemiological study with a follow-up of 5 years. SETTING:A comparison between depressed and nondepressed participants. PARTICIPANTS:The series consisted of the persons who participated i...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2001.4930290.x
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVES:To assess the frequency of diagnostic errors in older adults presenting to the emergency department (ED) with symptoms suggestive of Chikungunya virus infection (CVI) and to compare the rates of misdiagnosis of older and younger adults. DESIGN:Cross-sectional study performed in the University Hospitals of M...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15492
更新日期:2018-09-01 00:00:00
abstract:OBJECTIVES:To study the prevalence of dementia in Singapore among Chinese, Malays, and Indians. DESIGN:A two-phase, cross-sectional study of randomly selected population from central Singapore with disproportionate race stratification. SETTING:Community-based study. Subjects screened to have cognitive impairment at p...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2008.01992.x
更新日期:2008-11-01 00:00:00
abstract:BACKGROUND/OBJECTIVES:The extent to which the prevalence of muscle weakness in the US population varies by different putative grip strength constructs developed by the Sarcopenia Definitions and Outcomes Consortium (SDOC) has not been described. DESIGN:Cross-sectional analysis. SETTING:Two nationally representative c...
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abstract:OBJECTIVES:To determine the priority that older adults with coexisting hypertension and fall risk give to optimizing cardiovascular outcomes versus fall- and medication symptom-related outcomes. DESIGN:Interview. SETTING:Community. PARTICIPANTS:One hundred twenty-three cognitively intact persons aged 70 and older wi...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2008.01815.x
更新日期:2008-08-01 00:00:00
abstract:OBJECTIVES:To estimate the incidence of chronic activities of daily living (ADL) disability and to analyze the sociodemographic, health status, adverse lifestyle, and leisure-time physical activity predictors for chronic ADL disability. DESIGN:We recruited a cohort of community-dwelling older people in Taipei, Taiwan,...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1999.tb05231.x
更新日期:1999-09-01 00:00:00
abstract:OBJECTIVES:To determine to what extent demographic, social support, socioeconomic, geographic, medical, and End-of-Life (EOL) planning factors explain racial and ethnic variation in Medicare spending during the last 6 months of life. DESIGN:Retrospective cohort study. SETTING:Health and Retirement Study (HRS). PARTI...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.14263
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND/OBJECTIVES:The American College of Cardiology (ACC) Geriatric Cardiology Section Leadership Council recently outlined 4 key domains (which are composed of 14 subdomains) that are important to assess in older adults with heart failure (HF). We sought to determine which geriatric domains/subdomains are routine...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.16183
更新日期:2019-12-01 00:00:00
abstract::Clostridium difficile causes pseudomembranous colitis and is responsible for 20% to 25% of cases of postantibiotic diarrhea. In an earlier study, nursing-home patients with C. difficile infection were noted to have a high mortality rate. Because most of these infected patients had been treated with antibiotics, it was...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1990.tb03539.x
更新日期:1990-04-01 00:00:00
abstract:OBJECTIVES:To examine the association between alcohol intake and problem drinking history and bone mineral density (BMD), falls and fracture risk. DESIGN:Cross-sectional and prospective cohort study. SETTING:Six U.S. clinical centers. PARTICIPANTS:Five thousand nine hundred seventy-four men aged 65 and older. MEASU...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1532-5415.2006.00912.x
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Previous research has identified several barriers faced by clinicians in detecting and reporting elder abuse, such as lack of knowledge about the process to report suspected cases of abuse and lack of access to experts to consult with. A novel intervention was designed and tested that embedded two Adult Prot...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.16433
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVES:To describe the pattern and factors associated with daily medication use in nursing home (NH) residents with advanced dementia. DESIGN:Prospective cohort study. SETTING:Twenty-two Boston-area NHs. PARTICIPANTS:NH residents with advanced dementia (N=323). MEASUREMENTS:Data from residents' records were use...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2010.02819.x
更新日期:2010-05-01 00:00:00
abstract::The literature has identified significant successes in cardiac resuscitation with the use of automated external defibrillators (AEDs) in public areas. As of September 2004, the Food and Drug Administration has authorized the purchase of these devices by the general public without a prescription. For the practicing ger...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/j.1532-5415.2005.00569.x
更新日期:2006-01-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15833
更新日期:2019-07-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,随机对照试验
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更新日期:2010-01-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2004.52161.x
更新日期:2004-04-01 00:00:00
abstract:OBJECTIVES:To compare falls and fall-related injuries that a fall evaluator or hospital incident report identified with injuries identified according to discharge International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for the same set of inpatient episodes of care. DESIGN:Pros...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.12539
更新日期:2013-12-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2000.tb04701.x
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVES:To develop a prediction model for kidney transplantation (KT) outcomes specific to older adults with end-stage renal disease (ESRD) and to use this model to estimate the number of excellent older KT candidates who lack access to KT. DESIGN:Secondary analysis of data collected by the United Network for Organ...
journal_title:Journal of the American Geriatrics Society
pub_type: 社论,多中心研究
doi:10.1111/j.1532-5415.2011.03652.x
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVES:To estimate potential cost savings generated by a program of hip protectors in the nursing home from a Medicare perspective. DESIGN:A state-transition Markov model considering short-term and long-term outcomes of hip protectors for a hypothetical nursing home population, stratified by age, sex, and function...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53102.x
更新日期:2005-02-01 00:00:00
abstract::The Wisconsin Drug Utilization Review Project used Medicaid claims data to examine the use of long-term, full doses histamine-2 receptor antagonists (H2RAs) among long-term care facility (LTCF) residents, ie, doses exceeding 800 mg per day of cimetidine or 150 mg per day of ranitidine for 12 weeks or more. Additional ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1988.tb04024.x
更新日期:1988-06-01 00:00:00
abstract::Cardiovascular diseases and their treatment in the aged are discussed under the headings of ischemic heart disease, hypertension, cardiac failure (with special reference to the use of diuretics and digoxin), infective carditis and thyroid disorders. Advanced age modifies the approach to treatment; the choice of drugs ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/j.1532-5415.1975.tb00970.x
更新日期:1975-03-01 00:00:00
abstract::Catechol-O-methyltransferase (COMT) inhibitors are a new therapeutic option in the treatment of patients with Parkinson's disease. COMT inhibitors act by extending the duration of action of levodopa, thus improving the amount of time a patient can experience benefit from levodopa. COMT inhibitors are only used in conj...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/j.1532-5415.2000.tb04732.x
更新日期:2000-06-01 00:00:00
abstract::The 143 physicians who returned to Temple University Medical School a questionnaire on knowledge of prescribing for the elderly constituted 25% of a stratified random sample of general practitioners (GPs), family practitioners (FPs), and practitioners in internal medicine (IMs) reimbursed under Medicare in Pennsylvani...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1985.tb06318.x
更新日期:1985-09-01 00:00:00
abstract:OBJECTIVES:To improve screening for Alzheimer's disease (AD) with the Memory Impairment Screen (MIS), a 4-minute, four-item delayed free and cued recall memory test with controlled learning and high discriminative validity. To assess the discriminative validity of the MIS for AD and to compare it with the conventional ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2002.50265.x
更新日期:2002-06-01 00:00:00