305588
Variation in preventive medication for acute myocardial infarction in Taiwan: Evidence showing that universal coverage cannot provide equal access to optimal care
Preventive medication prescribed at discharge for acute myocardial infarction (AMI) is recommended by clinical practice guidelines. The prescribing rates of preventive medication have been widely used as quality indicators for the process of care at the provider-level. It remains unknown whether disparities in receiving preventive medication remain exist between socioeconomic classes and types of providers within a universal healthcare system in which drug costs are covered.
Methods
This study employed population-based claims data from the National Health Insurance database for the period 2008-2010. Patients who were admitted to hospital with AMI as their primary diagnosis were included in the study. The adherence rates of five types of drugs prescribed at discharge, including beta blockers, statins, ACEI/ ARB, aspirin and clopidogrel, were calculated for each hospital in each year. Hierarchical generalized linear modeling was used to assess the influence of types of hospital as well as the patient's socioeconomic status on the administration of preventive medication.
Results
A total of 41,237 AMI patients discharged from 258 hospitals (19 medical centers, 74 regional hospitals, 165 district, small hospitals) were included in this study. The mean adherence rates among medical centers, regional hospitals, and small hospitals in prescribing beta blockers (64.6%, 50.5%, 28.6%, respectively), statins (61.7%, 39.3%, 13.8%, respectively), ACEI/ ARB (75.5%, 60.3%, 38.3%, respectively), aspirin (90.6%, 82.3%, 53.9%, respectively) and clopidogrel (91.1%, 75.9%, 28.6%, respectively) varied greatly. The results of hierarchical generalized linear models show that after controlling for patient's age, gender, and year of index hospitalization, patients admitted to medical centers and regional hospitals were associated with high rates of administration of preventive medications (OR: 1.71-47.77,p<.001). In hospitals located in areas with lower educational levels, patients were less likely to receive statins and aspirin (OR: 0.06 and 0.22, p<.001). Patients with lower income levels were less likely to receive any of the other preventive medications (OR: 0.84-0.92,p<.001), with the exception of aspirin.
Conclusion
Our results illustrate the extreme variance in adherence to preventive medication for post-discharge AMI patients that remains under Taiwan's National Health Insurance. This study provides evidence that the expansion of coverage does not necessarily reduce all disparities. Actions to monitor and improve quality of care remain important, even in cases where health care costs are covered.
Learning Areas:
Administration, management, leadershipChronic disease management and prevention
Provision of health care to the public
Public health or related research
Learning Objectives:
Evaluate if disparities in receiving preventive medication remain exist within a universal healthcare system in which drug costs are covered;
Assess the influence of patient's socioeconomic status on the administration of preventive medication;
Compare the prescribing rates of preventive medication between different types of hospitals.
Keyword(s): Health Disparities/Inequities, Quality of Care
Qualified on the content I am responsible for because: The study is designed by me and completed by all the co-authors listed on the abstract.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.