April 24, 2013
Seniors in South at Much Greater Risk of Getting
High-Risk Drugs

Providence, RI—Heads up for pharmacists, especially those in the South: More than 21.4% of seniors in Medicare Advantage plans in 2009 received at least one “high-risk” medication, even when a safer alternative was available.

Another 4.8% of beneficiaries received at least two questionable prescriptions, according to the study of more than 6 million seniors in Medicare Advantage plans. It also noted that residents of the South Atlantic, East South Central, and West South Central regions of the country—an area stretching from parts of Texas to South Carolina—had a 10% to 12% greater risk of receiving potentially harmful prescriptions than those in New England, who had the lowest chance.

The analysis by Brown University experts, who looked at prescriptions for about 110 medications considered risky for the elderly, was published recently in the Journal of General Internal Medicine.

A list of the high-risk drugs used in the study is available here.

“At the population level it is clear that there is a unique phenomenon occurring,” said lead author Danya Qato, PharmD, MPH. “While one can reason that it might be appropriate for a particular patient to be on a particular medication, with such a preponderance of use of high-risk medications in some locations versus others, our results suggest that we cannot attribute this variation wholly to patient characteristics.”

Study authors noted that the trend continued when looking at hospital-referral regions (HRR). “The 20 lowest performing HRRs were all in the Southern region of the United States. In contrast, only one of the 20 highest performing HRRs was in the South.”

The peak rate of single high-risk prescriptions was in Albany, GA, where 38.2% of Medicare Advantage beneficiaries received one, with Alexandria, LA, the most likely for patients to receive two high-risk prescriptions at 13.5%.

At the lowest risk for one or two high-risk prescriptions were the elderly in Mason City, IA (9.6%) and Worcester, MA (0.7%), respectively.

In addition to geography, other risks for receiving an inappropriate prescription included female sex and lower economic status. Nationwide, women had a 10% greater likelihood than men of receiving a high-risk prescription, and residents of the poorest areas had a 2.7% higher risk than the residents of the richest areas.

Interestingly, enrollees who were African-American, members of other minority groups, or older than 85-years-old were less likely to receive these medications, according to the analysis.

While socioeconomic factors were taken into account in the analysis, the authors suggested a combination of factors led to higher prescribing of high-risk drugs in the South. They said those could include higher patient demand for the drugs, a different prescribing culture, possibly higher prevalence of chronic medical problems in the region, or inadequate medical training with regard to appropriate prescribing among elderly patients.

Pharmacists and other health professionals should be aware of the prescribing trends.

“This is one of the many reminders for patients to regularly review the appropriateness and safety of their medications with their pharmacist and physician,” Qato said. “Patients are often their own best advocates.”

U.S. Pharmacist Social Connect