142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

306468
Potential Effects of Racial and Ethnic Disparities in Meeting Medicare Medication Therapy Management Eligibility Criteria

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Junling Wang, PhD , Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, TN
Yanru Qiao , Department of Clinical Pharmacy, University of Tennessee College of Pharmacy
Ya-Chen Shih , University of Chicago Department of Medicine, Chicago, IL
Christina Spivey , Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, TN
Jim Wan, PhD , Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
Shelley White-Means , University of Tennessee Department of Clinical Pharmacy, Memphis, TN
Samuel Dagogo-Jack , University of Tennessee Health Science Center, Memphis, TN
William Cushman , Memphis Veterans Affairs Medical Center, Memphis, TN
Marie Chisholm-Burns , University of Tennessee College of Pharmacy, Memphis, TN
Objective: Examine racial and ethnic disparities in health status, health services utilizations and costs, and medication utilization based on Medicare medication therapy management (MTM) eligibility status. Greater disparities among MTM-ineligible than MTM-eligible individuals would suggest that MTM eligibility criteria have the potential to exacerbate racial and ethnic disparities in health outcomes.

Method: This is a retrospective cross-sectional analysis of the Medicare Current Beneficiary Survey (2007-2008). A difference-in-differences model was used by including in regression models interaction terms for, e.g., non-Hispanic Blacks and MTM eligibility criteria, when examining racial disparities. Both main and sensitivity analyses were conducted to represent the ranges of the MTM eligibility thresholds of 2010.

Results: Whites were more likely to report self-perceived good health status than Blacks and Hispanics among both MTM-eligible and MTM-ineligible populations. Disparities were greater among MTM-ineligible than MTM-eligible populations (e.g., on additive term, difference in odds=1.94; P<0.01 for Whites and Blacks; difference in odds=2.86; P<0.01 for Whites and Hispanics in main analysis). Examining racial disparities, activities of daily living, instrumental activities of daily living, and generic possession ratio produced similar findings. Whites had a higher number of physician visits than Hispanics and the disparities were greater among the MTM-ineligible than MTM-eligible individuals (IRR=1.40; P<0.01). Analyses on chronic conditions, costs of physician visits, hospitalizations, and total health care costs produced similar patterns on ethnic disparities. No other variables exhibited significant findings.

Conclusion: Current MTM eligibility criteria may potentially aggravate existing racial and ethnic disparities in health services utilization and costs and medication utilization measures.

Learning Areas:

Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
Analyze racial and ethnic disparities in health status, health services utilizations and costs, and medication utilization based on Medicare medication therapy management (MTM) eligibility status. Analyze whether there were greater disparities among MTM-ineligible than MTM-eligible individuals.

Keyword(s): Aging, Minority Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have spent over fifteen years in the fields of health outcomes research and health policy. My research has been funded by the National Institute on Aging/National Institutes of Health, American Association of Colleges of Pharmacy, Pharmaceutical Research and Manufactures of America Foundation, Eli Lilly, Pharmacy Quality Alliance and the Bureau of TennCare. I have published over 35 research articles in peer-reviewed journals, and have given almost 50 presentations in various professional meetings.
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.