Objectives:
To assess patients’ 1) satisfaction with their decision to enroll
or not enroll in the Medicare Part D program, and 2) clinical
status of diabetes before and after decision to enroll in Medicare
Part D.
Methods: Patients 65 years or older were enrolled in the study
from November 2006 through February 2007. Patients were screened
by a clinical pharmacist at their clinician visit and administered
a Medicare Part D satisfaction survey. Upon completion of the
survey, a retrospective chart review was completed in diabetic
patients who were enrolled in Medicare Part D to assess goal attainment
of glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL)
and blood pressure. Pre-enrollment values were obtained in the
6 months prior to the start of Medicare Part D enrollment (July
1- December 31, 2005). Post-enrollment values were obtained after
enrollment was complete for the 2006 year (May 1- October 31,
2006).
Results: Results show that 74% (60/81) of patients surveyed were
enrolled into the Medicare Part D program, including patients
who have dual eligibility. Of the 60 patients who were enrolled
in Medicare Part D, 48 patients (80.0%) responded that they were
satisfied with their decision to enroll. Clinical outcomes were
unchanged from the pre-enrollment to the post-enrollment periods.
Mean HbA1c was 7.47% in the pre-enrollment period and 7.25% post-enrollment
(differencepre-post = 0.23; 95%CI = -0.28 to 0.73). There was
no change in LDL in the two time periods (pre = 79.4 mg/dL; post
= 79.7; differencepre-post = -0.25; 95%CI = -13.6 to 13.1). Similarly,
there were no significant differences observed for blood pressure.
Mean systolic blood pressure was 129.5 in the pre-enrollment period
and 131.6 in the post-enrollment period (differencepre-post =
-2.1; 95%CI = -7.0 to 2.7). Mean diastolic blood pressure was
70.3 for the pre-enrollment period and 70.7 for the post-enrollment
period (differencepre-post = -0.4; 95%CI = -4.2 to 3.4).
Conclusion: Patients were generally satisfied with their decision
to enroll in Medicare Part D. Clinical outcomes were not affected
by participation in a Medicare Part D plan. More longitudinal
studies are necessary to determine long term impact of Medicare
Part D on diabetes management.
