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1.
Ann Fam Med ; 22(1): 45-49, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38253511

RESUMO

Gabapentinoids are commonly used medications for numerous off-label conditions. The 2002-2021 Medical Expenditure Panel Survey (MEPS) was used to investigate the proportion of the adult population who were gabapentinoid users, the ages of these users, medications and diagnoses associated with users, and the likelihood of starting, stopping, or continuing gabapentinoids. Gabapentinoid users continued to increase since our last publication from 4.0% in 2015 to 4.7% in 2021. Gabapentinoid use was much more likely among individuals who used other medications used in chronic pain. Between 2017-2021, numerous chronic pain conditions were associated with gabapentinoid use. New gabapentinoid users clearly outnumbered gabapentinoid stoppers between 2011-2012 and 2017-2018, but this difference decreased in the most recent cohorts.


Assuntos
Dor Crônica , Gabapentina , Adulto , Humanos , Dor Crônica/tratamento farmacológico , Estados Unidos , Gabapentina/uso terapêutico , Uso Off-Label
2.
J Gen Intern Med ; 36(3): 699-704, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32968967

RESUMO

OBJECTIVE: Antihypertensives are the most used medication type in the USA, yet there remains uncertainty about the use of different antihypertensives. We sought to characterize use of antihypertensives by and within medication class(es) between 1997 and 2017. PATIENTS AND METHODS: A repeated cross-sectional study of 493,596 adult individuals using the 1997-2017 Medical Expenditure Panel Survey (MEPS). The Orange Book was used for adjunctive information. The primary outcome was the estimated use by and within antihypertensive medication class(es). RESULTS: The proportion of individuals taking any antihypertensive during a year increased from 1997 to the early 2010s and then remained stable. The proportion of adults using angiotensin II receptor blockers (ARBs) and dihydropyridine calcium channel blockers (CCBs) increased during the study period, while angiotensin-converting enzyme inhibitors (ACE-Is) increased until 2010 after which rates remained stable. Beta-blocker use was similar to that of ACE-Is with an earlier decline starting in 2012. Thiazide diuretic use increased from 1997 to 2007, leveled off until 2014, and declined from 2015 to 2017. Non-dihydropyridine CCB use declined throughout the study. ACE-Is, ARBs, CCBs, thiazide diuretics, and loop diuretics all had one dominant in-class medication. There was a clear increase in the use of losartan within ARBs, lisinopril within ACE-Is, and amlodipine within CCBs following generic conversion. Furosemide and hydrochlorothiazide started with and maintained a dominant position in their classes. Metoprolol use increased throughout the study and became the dominant beta-blocker. CONCLUSIONS: Antihypertensive classes appear to have a propensity to equilibrate to an individual medication, despite a lack of outcomes-based research to compare medications within a class.


Assuntos
Anti-Hipertensivos , Hipertensão , Adulto , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Anti-Hipertensivos/uso terapêutico , Estudos Transversais , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Estados Unidos/epidemiologia
3.
Ann Fam Med ; 19(1): 41-43, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33431390

RESUMO

We sought to describe the proportion of patients in contact with a primary care physician, as well as the total number of primary care contacts over a 2-year period, using the 2002-2017 Medical Expenditure Panel Survey. The rate of any contact with a primary care physician for patients in the population decreased by 2.5% over the study period (adjusted odds ratio [aOR] = 0.99 per panel, 95% CI, 0.98-0.99; P <.001). The number of contacts with a primary care physician decreased among individuals with any contact by 0.5 contacts over 2 years (aOR = -0.04 per panel, 95% CI, -0.04 to -0.03, P <.001). The decreases were observed across all age groups at varying rates. The results of this study suggest that the driver for the previously reported decreases in primary care visits is secondary to fewer contacts per patient.


Assuntos
Continuidade da Assistência ao Paciente , Gastos em Saúde , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Transversais , Pesquisa sobre Serviços de Saúde , Humanos , Inquéritos e Questionários
4.
Ann Fam Med ; 18(5): 430-437, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32928759

RESUMO

PURPOSE: Total and out-of-pocket visit expenditures for primary care physician visits may affect how primary care is delivered. We determined trends in these expenditures for visits to US primary care physicians. METHODS: Using the 2002-2017 Medical Expenditure Panel Survey, we ascertained changes in total and out-of-pocket visit expenditures for primary care visits for Medicare, Medicaid, and private insurance. We calculated mean values for each insurer using a generalized linear model and a 2-part model, respectively. RESULTS: Analyses were based on 750,837 primary care visits during 2002-2017. Over time, the proportion of primary care visits associated with private insurance or no insurance decreased, while Medicare- or Medicaid-associated visits increased. The proportion of visits with $0 out-of-pocket expenditure increased, primarily from an increase in $0 private insurance visits. Total expenditure per visit increased for private insurance and Medicare visits, but did not notably change for Medicaid visits. Out-of-pocket expenditures rose primarily from increases in private insurance visits with higher expenditures of this type. Medicare and Medicaid had minimal change in out-of-pocket expenditure per visit. CONCLUSIONS: Between 2002 and 2017, mean total expenditures and out-of-pocket expenditures increased for primary care visits, but at notably lower rates than those previously documented for emergency department visits. A rise in total expenditure per visit was identified for private insurance and Medicare, but not for Medicaid. Out-of-pocket expenditures increased marginally related to changes in out-of-pocket expenditures for private insurance visits. We would expect increasing difficulty with primary care physician access, particularly for Medicaid patients, if the current trends continue.


Assuntos
Gastos em Saúde/tendências , Seguro Saúde/economia , Visita a Consultório Médico/economia , Médicos de Atenção Primária/economia , Atenção Primária à Saúde/economia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Estados Unidos
6.
Ann Fam Med ; 17(6): 526-537, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31712291

RESUMO

BACKGROUND: The initial ecology of medical care study was published in 1961, offering a framework by which to investigate individuals' contact with the medical system. We studied changes in the framework around the implementation of the Patient Protection and Affordable Care Act (ACA) within longer-term trends. METHODS: The 2002-2016 Medical Expenditure Panel Survey was used to determine rates of visit/contact per 1,000 individuals per month for physicians, primary care physicians, specialty physicians, emergency departments, inpatient hospitalizations, dental visits, and home health visits for the overall population and by age group, poverty category, health status, and race/ethnicity. Adjusted Wald tests were used to investigate differences between the pre-ACA (2012-2013) and post-ACA (2014-2015) periods. Multivariable linear regression was used to determine trends over the study period (2002-2016). RESULTS: The survey included 525,804 person-years. The uninsured rate decreased from 12.8% (95% CI, 12.0%-13.7%) in 2013 to 7.6% (95% CI, 7.0%-8.3%) in 2016. From 2002 to 2016, the numbers of individuals in a month who had contact with primary care physicians, dental care, and inpatient hospitalizations decreased. Primary care physician contact decreased most among the elderly and those reporting fair/poor health. After ACA implementation, few significant changes were identified in the overall population or by age, poverty category, race/ethnicity, or health status. CONCLUSIONS: The medical ecology framework was not notably altered 2 years after implementation of the ACA. The long-term decrease in primary care contact does not appear to have been interrupted after implementation of the ACA, was observed across income and age categories, and was most evident among the elderly and individuals reporting fair/poor health.


Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Medicina Geral/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/tendências , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Cobertura do Seguro/tendências , Modelos Lineares , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Análise Multivariada , Estados Unidos , Adulto Jovem
9.
Ann Emerg Med ; 74(3): 317-324, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31221498

RESUMO

STUDY OBJECTIVE: Per visit, emergency department (ED) expenditures have increased more for private insurance than Medicare and Medicaid during the past 20 years, but it is unknown whether ED out-of-pocket expenditures show a similar pattern of increase. We compare increases in per-visit ED out-of-pocket expenditures over time for visits that did not result in hospitalization or observation admissions for private insurance, Medicare, and Medicaid. METHODS: This repeated cross-sectional analysis of out-of-pocket expenditures used data from the 1999 to 2016 Medical Expenditure Panel Survey, a nationally representative survey of the noninstitutionalized US civilian population. We used 2-part models-logistic regression followed by a generalized linear model with a γ distribution and a log link function-to compare per-visit out-of-pocket expenditures over time among different payers. Models contained insurance type, year, an interaction between year and insurance type, region of country, sex, and 5 visit-level variables (magnetic resonance imaging/computed tomography scans, ultrasonography, surgical procedures, radiographs, and ECGs). RESULTS: In our sample of 107,519 ED visits, mean annual per-visit out-of-pocket expenditures increased $7.31 a year (95% confidence interval $6.22 to $8.41) for private insurance and did not increase for Medicare or Medicaid. Most private insurance and Medicare visits had out-of-pocket expenditures less than $100 and nearly all Medicaid visits had no out-of-pocket expenditures. There was no strong evidence suggesting that out-of-pocket expenditures at different total expenditure amounts increased appreciably for private insurance. CONCLUSION: Per-visit out-of-pocket expenditure increases for private insurance ED visits were predominantly related to overall increases in per-visit total expenditure.


Assuntos
Serviços Médicos de Emergência/economia , Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/economia , Estudos Transversais , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Modelos Logísticos , Estados Unidos
11.
Ann Fam Med ; 15(4): 313-321, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28694266

RESUMO

PURPOSE: This study compared ecology (number of individuals using a service), utilization (number of services used), and expenditures (dollars spent) for various categories of medical services between primarily 1996-1997 and 2011-2012. METHODS: A repeated cross-sectional study was performed using nationally representative data mainly from the 1996, 1997, 2011, and 2012 Medical Expenditure Panel Survey (MEPS). These data were augmented with the 2002-2003 MEPS as well as the 1999-2000 and 2011-2012 National Heath and Nutrition Examination Survey. Individuals (number per 1,000 people), utilization, and expenditures during an average month in 1996-1997 and 2011-2012 were determined for 15 categories of services. RESULTS: The number of individuals who used various medical services was unchanged for many categories of services (total, outpatient, outpatient physician, users of prescribed medications, primary care and specialty physicians, inpatient hospitalization, and emergency department). It was, however, increased for others (optometry/podiatry, therapy, and alternative/complementary medicine) and decreased for a few (dental and home health). The number of services used (utilization) largely mirrored the findings for individual use, with the exception of an increase in the number of prescribed medications and a decrease in number of primary care physician visits. There were large increases in dollars spent (expenditures) in every category with the exception of primary care physician and home health; the largest absolute increases were in prescribed medications, specialty physicians, emergency department visits, and likely inpatient hospitalizations. CONCLUSIONS: Although the number of individuals with visits during an average month and the total utilization of medical services were largely unchanged between the 2 time periods, total expenditures increased markedly. The increases in expenditure varied dramatically by category.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Transversais , Gastos em Saúde/tendências , Serviços de Saúde/tendências , Humanos , Estados Unidos
13.
Cancer ; 120(21): 3378-84, 2014 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-24962682

RESUMO

BACKGROUND: Medicare Part D was designed to reduce out-of-pocket (OOP) costs for Medicare beneficiaries, but to the authors' knowledge the extent to which this occurred for patients with cancer has not been measured to date. The objective of the current study was to examine the impact of Medicare Part D eligibility on OOP cost for prescription drugs and use of medical services among patients with cancer. METHODS: Using the Medical Expenditure Panel Survey (MEPS) for the years 2002 through 2010, a differences-in-differences analysis estimated the effects of Medicare Part D eligibility on OOP pharmaceutical costs and medical use. The authors compared per capita OOP cost and use between Medicare beneficiaries (aged ≥65 years) with cancer to near-elderly patients aged 55 years to 64 years with cancer. Statistical weights were used to generate nationally representative estimates. RESULTS: A total of 1878 near-elderly and 4729 individuals with Medicare were included (total of 6607 individuals). The mean OOP pharmaceutical cost for Medicare beneficiaries before the enactment of Part D was $1158 (standard error, ±$52) and decreased to $501 (standard error, ±$30), a decline of 43%. Compared with changes in OOP pharmaceutical costs for nonelderly patients with cancer over the same period, the implementation of Medicare Part D was associated with a further reduction of $356 per person. Medicare Part D appeared to have no significant impact on the use of medications, hospitalizations, or emergency department visits, but was associated with a reduction of 1.55 in outpatient visits. CONCLUSIONS: Medicare D has reduced OOP prescription drug costs and outpatient visits for seniors with cancer beyond trends observed for younger patients, with no major impact on the use of other medical services noted.


Assuntos
Custos de Medicamentos , Medicare Part D/economia , Neoplasias/economia , Neoplasias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Coleta de Dados , Feminino , Financiamento Pessoal/economia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Medicamentos sob Prescrição , Estados Unidos
18.
J Am Board Fam Med ; 2022 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-36096657

RESUMO

BACKGROUND: Rates of individuals with a psychotherapy visit has not been well studied, and recent reports lack granularity by age. METHODS: The 2017-2019 Medical Expenditure Panel Survey (MEPS) was used to investigate rates and associations of psychotherapy and psychiatry visits by age/sex and antidepressant/antipsychotic use. RESULTS: The study included all 90,853 individuals, of which 5.2% (95% CI, 4.9-5.4) reported any psychotherapy (excluding psychiatry visits) visit during a year, while 3.6% (95% CI, 3.4-3.8) reported a visit with a psychiatrist. Females were more likely to have a psychotherapy visit than males after 15 years of age. The highest rates of females with a psychotherapy visit were between 15 and 30 years of age, while rates among males were highest between 10 to 25 years of age. For psychiatry visits, males had higher rates than females during preteen years, similar rates through teen years, lower rates though adulthood, and similar rates after 60 years of age. Rates of a psychiatry visit did not vary as much by age as a psychotherapy visit. Among antidepressant or antipsychotic medication users, the rate of either a psychotherapy visit or a psychiatry visit during a year was markedly higher at younger ages and decreased as age advanced. CONCLUSION: Psychotherapy and psychiatry utilization have differences in population level patterns with use being highest among females between 15 to 30 years of age and higher among younger (compared with older) individuals who reported antidepressants or antipsychotics.

19.
J Am Board Fam Med ; 34(4): 732-740, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34312266

RESUMO

PURPOSE: This study aimed to determine the rates of psychiatric medication users in the United States between 1999 to 2018 for different medication categories by age and sex. METHODS: The 1999 to 2002, 2006 to 2009, and 2015 to 2018 Medical Expenditure Panel Surveys (MEPS) were used for the analysis. All individuals with a valid age were included. Any antidepressant, benzodiazepine, attention deficit hyperactivity disease (ADHD) medication, antipsychotics, and mood stabilizer report use was defined as a medication user. Separate multivariable logistic regression predicted medication users by age with restricted cubic splines by sex, medication category, and year category (1999 to 2002, 2006 to 2009, and 2015 to 2018). In addition, the rate of prescribing to males and females at different ages was determined for medication categories. RESULTS: Rates of any psychiatric medication users increased during the study period. Females had higher rates of medication users around 20 years of age. Rates of antidepressant users increased over time and were higher for females after earlier adolescence. Rates of benzodiazepine users were higher for females, increased after 1999 to 2002, and had consistent patterns of use over time. Antipsychotic and mood stabilizer user rates were lower than other categories. Adolescent antipsychotic users markedly decreased between 2006 to 2009 and 2015 to 2018. Rates of ADHD medication users increased over time, particularly among younger adults between 25 and 50 years of age. CONCLUSION: The rates of individuals reporting the use of any psychiatric medications increased over the last few decades. Rates and patterns of medication users have large variations by medication category, age, and sex, but these patterns of use were stable for most medication categories.


Assuntos
Uso de Medicamentos , Transtornos Mentais , Psicotrópicos , Adolescente , Criança , Pré-Escolar , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Estados Unidos/epidemiologia
20.
Clin Cardiol ; 43(12): 1376-1387, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33165977

RESUMO

Sodium glucose contrasporter 2 inhibitors (SGLT2i) were initially introduced as a novel class of modestly effective antiglycemics. Over the last 5 years, multiple members of this class have been examined for their cardiovascular safety, effects on heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) in diverse populations with or without diabetes type 2. The plethora of studies and outcomes examined make it difficult for the practitioner to track the entirety of the evidence. SGLT2i improve cardiorenal outcomes and have a beneficial risk benefit ratio across populations with cardiovascular disease, HFrEF and kidney disease. In this quantitative review, we synthesize the data from the large outcomes trials about the benefits and risks of SGLT2i. SGLT2i reduce all cause, cardiovascular mortality, heart failure hospitalizations, need for dialysis and acute kidney injury as a class effect across a broad range of populations with diabetes Type 2 at risk for cardiovascular disease, patients with HFrEF or CKD with or without diabetes. While certain adverse events for example, diabetic ketoacidosis and genital mycotic infections are reproducibly increased by SGLT2i, the absolute increase in the risk of these complications is smaller than the absolute risk reductions conferred by SGLT2i. Other complications such as amputations, fractures and urinary tract infections are increased to a lesser degree, or not at all (e.g., hypoglycemia). Overall, SGLT2is appear to have a favorable safety profile and thus should be used by cardiologists, nephrologists, endocrinologists, primary care physicians when managing the cardiorenal risk of their patients.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/complicações , Insuficiência Renal Crônica/complicações , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Ensaios Clínicos como Assunto , Diabetes Mellitus Tipo 2/complicações , Humanos
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