Pilot assessment of patient satisfaction and clinical impact of Medicare Part D in diabetic geriatric patients
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.
2. Ashkenazy R, Abrahamson M. Medicare Coverage for Patients with Diabetes. J Gen Intern Med. 2006;21:386-392.
3. Centers for Medicare and Medicaid. Formulary Review Guidelines. Available at: http://www.cms.hhs.gov/PrescriptionDrugCovContra/03_RxContracting_FormularyGuidance.asp#TopOfPage. Accessed August 17, 2006.
4. Piette J, Wagner T, Potter M, Schillinger D. Health insurance status, cost-related medication underuse, and outcomes among diabetes patients in three systems of care. Med Care. 2004;42(2):102-109.
5. Soumerai SB, Pierre-Jacques M, Zhang F, Ross-Degnan D, Adams AS, Gurwitz J, Adler G, Safran DG. Cost-related medication nonadherence among elderly and disabled Medicare beneficiaries. Arch Intern Med. 2006;166(17):1829-1835.
6. Piette J, Heisler M, Wagner T. Cost-related medication underuse among chronically ill adults: the treatments people forgo, how often, and who is at risk. Am J Public Health. 2004;94(10):1782-1787.
7. Spertus J, Decker C, Woodman C, House J, Jones P, O’Keefe J, Borkon AM. Effect of difficulty affording health care on health status after coronary revascularization Circulation. 2005;111(20):2572-2578.
8. Kennedy J, Coyne J, Sclar D. Drug affordability and prescription noncompliance in the United States: 1997-2002. Clin Ther. 2004;26(4):607-614.
9. Shinogle J, Wiener J. Medication use among Medicaid users of home and community-based services. Health Care Financ Rev. 2006;28(1):103-106.
10. Jackson J, Doescher M, Saver B, Fishman P. Prescription drug coverage, health, and mediation acquisition among seniors with one or more chronic conditions. Med Care. 2004;42(11):1056-1065.
11. Joyce G, Goldman D, Karaca-Mandic P, Zheng Y. Pharmacy benefit caps and the chronically ill. Health Aff. 2007;26(5):1333-1344.
12. Steinman M, Sands L, Covinsky K. Self-restriction of medications due to cost in seniors without prescription coverage. J Gen Intern Med.2001;16(12):793-799.
13. Centers for Medicare and Medicaid. Auto-Enrollment and Facilitated Enrollment of Low Income Populations. Available at: www.cms.hhs.gov/States/Downloads/AutoversusFacilitatedEnrollment.pdf. Accessed October 29, 2007.
14. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2006; 29:S4-S42.
15. Centers for Medicare and Medicaid. Bridging the Coverage Gap. Available at: http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/01a_bridgingthegap.asp#TopOfPage. Accessed November 21, 2007.
16. Keenan, Teresa. Prescription drugs research report. 2007 November. Available at: http://www.aarp.org/research/health/drugs/rx_medicare d.html. Accessed April 20, 2008.
17. Heiss F, McFadden D, Winter J. Who failed to enroll in Medicare Part D, and why? Early results. Health Aff (Milwood). 2006;25(5):w344-354.
18. Tjia J, Schwartz JS. Will the Medicare prescription drug benefit eliminate cost barriers for older adults with diabetes mellitus? J Am Geriatr Soc. 2006;54(4):606-612.
19. Hsu J, Fung V, Price M, Huang J, Brand R, Hui R, Fireman B, Newhouse JP. Medicare beneficiaries' knowledge of Part D prescription drug program benefits and responses to drug costs. JAMA. 2008;299(16):1929-1936.
20. Madden JM, Graves AJ, Zhang F, Adams AS, Briesacher BA, Ross-Degnan D, Gurwitz JH, Pierre-Jacques M, Safran DG, Adler GS, Soumerai SB. Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D. JAMA. 2008;299(16):1922-1928.
21. Kaiser Family Foundation/Harvard School of Public Health survey. Seniors and the Medicare Prescription Drug Benefit. Available at: www.kff.org. Accessed April 26, 2007.
22. Fuke D, Hunt J, Siemienczuk J, Estoup M, Carroll M, Payne N, Touchette D. Cholesterol management of patients with diabetes in a primary care practice-based research network. Am J Manag Care. 2004;10(2 Pt 2):130-136.
23. Mangione CM, Gerzoff RB, Williamson DF, Steers WN, Kerr EA, Brown AF, Waitzfelder BE, Marrero DG, Dudley RA, Kim C, Herman W, Thompson TJ, Safford MM, Selby JV; TRIAD Study Group. The association between quality of care and the intensity of diabetes disease management programs. Ann Intern Med. 2006:145(2):107-116.
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.