USE OF INEFFECTIVE OR UNSAFE MEDICATIONS AMONG MEMBERS OF A MEDICARE HMO COMPARED TO INDIVIDUALS IN A MEDICARE FEE-FOR-SERVICE PROGRAM

Adverse drug reactions and inappropriate prescribing practices are an important cause of hospitalization, morbidity, and mortality in the el derly. This study compares prescribing practices within a Medicare ris k contract health maintenance organization (HMO) in 1993 and 1994 with prescribing practices for two nationally representative samples of el derly individuals predominantly receiving medical care within the Medi care fee-for-service sector. Information on prescriptions in the fee-f or-service sector came from the 1987 National Medical Expenditures Sur vey (NMES) and the 1992 Medicare Current Beneficiary Survey (MCBS). A total of 20 drugs were studied; these drugs were deemed inappropriate for the elderly because their risk of causing adverse events exceeded their health benefits, according to a consensus panel of experts in ge riatrics and pharmacology. One or more of the 20 potentially inappropr iate drugs was prescribed to 11.53% of the Medicare HMO members in 199 4. These medications were prescribed significantly less often to HMO m embers in 1994 than to individuals in the fee-for-service sector, base d on information from both the 1987 NMES and the 1992 MCBS. Utilizatio n of unsafe or ineffective medications actually decreased with increas ing age in the HMO sample, with lowest rates in individuals over the a ge of 85. However, no relationship between age and medication use was seen in the NMES study, except for individuals over the age of 90 year s. The study data support the conclusion that ineffective or unsafe me dications were prescribed less often in the Medicare HMO than in natio nal comparison groups. In fact, for the very old, who are most at risk , the use of these medications was much lower in the Medicare HMO than in the Medicare fee-for-service sector. Nevertheless, in 1994, approx imately one of every nine members of this Medicare HMO received at lea st one such medication. Continued efforts and innovative strategies to further reduce the use of unsafe and ineffective drugs among elderly Medicare HMO members are needed.