Potentially Inappropriate Medication Use in a Medicare Managed Care Population: Association with Higher Costs and Utilization

Abstract

OBJECTIVE: To describe the prevalence of potentially inappropriate medication (PIM) use (defined by the Beers criteria) and association with resource utilization in a Medicare managed care population. METHODS: Retrospective review of a health maintenance organization (HMO) administrative database claims data for a subset of Medicare managed care patients 65 years of age and older to compare persons on PIMs (cases) with persons not on PIMs (comparisons). Measures included costs, inpatient and outpatient utilization, number of prescriptions, patient demographics, diagnoses, prescriber information, clinical data including self-rated health, and the Charlson Comorbidity Index. RESULTS: The prevalence of PIM use in this Medicare managed care population was 24.2% (541/2,336). Eighty eight of the 146 individuals on two or more inappropriate medications had 4-13 providers prescribing all their medications. Those on a PIM had significantly higher total, provider, and facility costs, and a higher mean number of inpatient, outpatient, and emergency room visits than comparisons after controlling for sex, Charlson comorbidity index, and total number of prescriptions. CONCLUSIONS: Our study revealed a high prevalence of potentially inappropriate medication use among older adults in a managed care plan and an association with high resource utilization. In this study, we sought to gather evidence to guide the future development of an intervention and educational program to decrease the use of high-risk medications in older adults.