Association between medication supplies and healthcare costs in older adults from an urban healthcare system

Journal Name: 
J Am Geriatr Soc
OBJECTIVES: The amount of medication dispensed to older adults for the treatment of chronic disease must be balanced carefully. Insufficient medication supplies lead to inadequate treatment of chronic disease, whereas excessive supplies represent wasted resources and the potential for toxicity. We used an electronic medical record system to determine the distribution of medications supplied to older urban adults and to examine the correlations of these distributions with healthcare costs and use. DESIGN: A cross-sectional study using data acquired over 3 years (1994-1996). SETTING: A tax-supported urban public healthcare system consisting of a 300-bed hospital, an emergency department, and a network of community-based ambulatory care centers. PATIENTS: Patients were >60 years of age and had at least one prescription refill and at least two ambulatory visits or one hospitalization during the 3-year period. MEASUREMENTS: Focusing on 12 major categories of drugs used to treat chronic diseases, we determined the amounts and direct costs of these medications dispensed to older adult patients. Amounts of medications that were needed by patients to medicate themselves adequately were compared with the medication supply actually dispensed considering all sources of care (primary, emergency, and inpatient). We calculated the excess drug costs attributable to oversupply of medication (>120% of the amount needed) and the drug cost reduction caused by undersupply of medication (120% of their needed medications had excess direct medication costs of $279,084 or $144 per patient, whereas patients receiving
1480, 80, admission, Adult, Aged, Ambulatory, Ambulatory Care, Chronic Disease, Chronic Disease: drug therapy: economics, cost, Cost-Benefit Analysis, Cross-Sectional Studies, Disease, Drug Costs, Drug Costs: statistics & numerical data, electronic, Emergencies, Female, Health Care Costs, Health Services for the Aged: economics, hospital, Hospitalization, Human, Indiana, Lead, Male, medical, Middle Age, older, patient, Patient Admission: economics, Patients, Pharmaceutical Preparations: supply & distribution, Record, ResNet, Support,Non-U.S.Gov't, system, Uncompensated Care: economics, Urban Health, utilization