4003.0: Tuesday, November 14, 2000 - 8:52 AM

Abstract #9238

Impact of physician monitoring on appropriateness of BZ prescribing in Medicaid risk groups

Linda Simoni-Wastila, PhD1, Dennis Ross-Degnan, ScD2, Xiaoming Gao2, Jeffrey Brown, MA1, Connie Mah2, Leon Cosler, PhD3, Thomas Fanning3, Peter Gallagher3, Carl Salzman, MD2, Richard Platt, MD2, Tom Inui, MD2, and Stephen Soumerai, ScD2. (1) Schneider Institute for Health Policy, Brandeis University, MS 035, 415 South Street, Waltham, MA 02454-9110, 781-736-3915, wastila@brandeis.edu, (2) Department of Ambulatory Care and Prevention, Harvard University, 126 Brookline Avenue, Suite 200, Boston, MA 02215, (3) Office of Medicaid Management, New York Department of Health, Empire Plaza, Corning Tower, 20th Floor, Room 2053, Albany, NY 12237

In conjunction with rising costs, the potential for abuse and diversion of psychoactive prescription drugs increasingly has caused many states to implement use and cost controls. These policies and regulations are often undertaken with little consideration for their impact on patient outcomes, particularly regarding appropriateness of treatment. This paper examines the impact of one such policy regulating the use of benzodiazepines (BZs) - the triplicate prescription program (TPP) - on the utilization of BZs, potential BZ substitutes, and other, non-drug services, such as outpatient physician visits and hospital admissions by clinically vulnerable beneficiaries in the New York Medicaid population. In this study, risk groups are those identified as having one of the following diagnoses: seizure disorder, panic disorder, schizophrenia, and bipolar disorder. We use data for two three-year cohorts (1988-1990) developed from New York (study group) and New Jersey (control group) Medicaid eligibility and claims data. We use descriptive analyses to compare the demographic and clinical profiles of the two study cohorts, as well as to determine baseline patterns of BZ and other psychoactive drug use. Using segmented linear regression time series models, we estimate changes in levels and trends in the prevalence of specific indicators of appropriateness of use and dosing of BZs and substitute drugs. We also test for statistically significant differences in levels and trend in New York following TPP implementation.

Learning Objectives: 1. To understand how benzodiazepine regulation may affect access to benzodiazpines by vulnerable populations. 2. To examine appropriateness of benzodiazepine prescribing within risk groups. 3. To examine potentially appropriate and inappropriate drug substitution by risk groups impacted by BZ regulation

Keywords: Prescription Drug Use Patterns, Vulnerable Populations

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA