Date of Award

Fall 2013

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Pharmacy Practice

First Advisor

Joseph Thomas III

Committee Chair

Joseph Thomas III

Committee Member 1

Bruce A. Craig

Committee Member 2

Gail D. Newton

Committee Member 3

Mark M. Moriarty

Abstract

The objectives for this study were to determine prevalence and incidence of potentially inappropriate medication (PIM) use among community-dwelling Medicare Part D beneficiaries, and to assess associations between patients' perceptions of provider communication, provider knowledge, and provider competence with PIM use. A retrospective observational analysis was conducted using data from the Medicare Current Beneficiary Survey. Individuals were included in the prevalence sample if they were aged 65 years or older in 2008, continuously enrolled in Medicare Part D from October 2007 through December 2008, and living in the community from October 2007 through December 2008. Individuals were included in the incidence sample if they were aged 65 years or older in 2008, continuously enrolled in Medicare Part D from October 2007 through December 2008, living in the community from October 2007 through December 2008, and did not receive any PIMs during the last quarter of 2007. Potentially inappropriate medications were identified based on the 2012 Beers criteria in each of four broad categories including inappropriate drug choice, excess dose, excess duration, and drug-disease interaction. Patients' perceptions of provider communication, provider knowledge, and provider competence were assessed using previously validated indices. Multiple logistic regression models were developed to examine associations between patients' perceptions of provider communication, provider knowledge, and provider competence and PIM use. One-year prevalence of PIM use among community-dwelling Medicare Part D beneficiaries was 27.6 percent for inappropriate drug choice PIMs, 3.3 percent for excess dose PIMs, 3.5 percent for excess duration PIMs, and 3.2 percent for drug-disease interaction PIMs. Overall one-year prevalence of use of any PIM was 33.0 percent. One-year incidence of PIM use among community-dwelling Medicare Part D beneficiaries was 17.2 percent for inappropriate drug choice PIMs, 1.2 percent for excess dose PIMs, 2.6 percent for excess duration PIMs, and 1.8 percent for drug-disease interaction PIMs. Overall one-year incidence of use of any PIM was 20.7 percent. Individuals with more positive perceived provider knowledge scores of six (OR=0.62, 95% CI=0.39 to 0.97, p=0.036), seven (OR=0.44, 95% CI=0.22 to 0.87, p=0.018), or eight (OR=0.55, 95% CI=0.34 to 0.88, p=0.012) were less likely than those with scores ranging from two to five to receive PIMs identified in the inappropriate drug choice category after adjusting for demographic and clinical characteristics. There were no associations found between perceived provider communication or perceived provider competence and PIM use.

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