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Are There Regional Differences in Elderly Health?

Sarah Stevenson
By Sarah StevensonOctober 29, 2013

A new report finds huge variations in prescription rates for elderly Americans depending on where they live, but does this reflect actual regional differences in elderly health?

Scary as it sounds, seniors in some regions of the U.S. might be getting too many—or too few—prescriptions, according to a new report, the Dartmouth Atlas of Medicare Prescription Drug Use. The report, which looked at geographic variations in the drugs prescribed to elderly Medicare patients in 2010, found huge regional differences in prescription rates for serious medications like antidepressants and dementia drugs. The question is, do these disparities indicate actual regional differences in elderly health? For instance, almost a third of elderly patients in the Miami area were prescribed antidepressants, versus just 7 percent in Honolulu. Are seniors in Florida more depressed, or are there other factors at work?

The Dartmouth Report: Regional Differences in Senior Prescriptions

Because not much is known about patterns of prescription drug use in Medicare Part D enrollees, the Dartmouth Institute for Health Policy and Clinical Practice conducted their study to look at regional prescription rates throughout the U.S. for various classes of drugs. They looked at prescriptions for medications that were obviously necessary, prescription rates for drugs that may be potentially harmful and should be prescribed with great care, and even “discretionary” medications that are of uncertain benefit.

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The media website ProPublica, which conducted its own investigation earlier this year, found that some doctors who treat Medicare patients may prescribe drugs that are inappropriate in certain cases—yet not much has been done to study these Part D prescribing patterns in detail. The Dartmouth study changes all that. The researchers looked at the percentage of patients in each region who received particular prescriptions. A few of the key findings:

  • The highest rate of prescription drug use overall was in Miami: Medicare beneficiaries on average filled about 63 prescriptions in 2010. Grand Junction, Colorado, had the lowest rate, with seniors filling about 39 prescriptions. The national average was 49.
  • Antidepressants, which are considered discretionary medications, were prescribed most often in—again—Miami, with 30 percent of beneficiaries filling at least one prescription in 2010. Honolulu, Hawaii, on the other hand, reported only 7 percent of seniors receiving antidepressant prescriptions.
  • Dementia medications, which can have major side effects, were prescribed most often in Miami, with 17 percent of seniors filling at least one such prescription. Rather tellingly, in Rochester, MN—home of the Mayo Clinic, which researches various types of dementia—the rate was lowest in the country, at 3.7 percent.

Do Prescription Rates Match Up with Elderly Health Differences?

The study tells us a lot about how medications are being used by the elderly in different regions. Here’s the catch, though, as noted in a recent ProPublica article about the study: “The report does not address whether the patients had diagnoses that would warrant the use of these medications.”

The information may NOT reflect actual patterns of illness in the population—so there’s no reason to worry that your loved one will have a higher chance of developing depression if he or she retires to Florida, for instance. In fact, according to the CDC, the percentage of seniors 65 and older with current depression in Florida was just over 4 percent in 2006. On the other hand, in 2011, about 21 percent of seniors in Miami were reported to have Alzheimer’s disease or a related condition (Health Indicators Warehouse).

Why this Study is Important

Do the above numbers mean that Miami seniors are being overprescribed antidepressants? That’s one of the questions raised by the report, and one that the researchers hope will get answered over time. The study’s authors speculate that in some regions patients may not be sufficiently informed about the risks and benefits of prescriptions, resulting in different prescription rates in different areas. This could put elderly patients in those areas at higher risk, whether it’s through underprescribing effective medications or overprescribing those that might be hazardous.

“As the population ages and prescription drugs take on an increasing role in health and health care, a detailed evaluation of how drugs are used in Part D is needed to understand the quality and value of the care being delivered,” says the study. The authors want policymakers to work on ways to lower geographic variation in medication prescription rates. Patients and their families also need to exercise some vigilance and ask their doctors whether a drug is right for them, so that you can make sure your loved ones are getting the medications they truly need—and not unnecessary medications that they don’t need.

Feel free to share your opinions of the new study in the comments below.

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Sarah Stevenson
Sarah Stevenson

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