First-ever Dartmouth Atlas report on prescriptions finds wide variation in the use of both effective and potentially harmful medications across US
A new report from the Dartmouth Atlas Project shows that the use of both effective and risky drug therapies by Medicare patients varies widely across U.S. regions, offering further evidence that location is a key determinant in the quality and cost of the medical care that patients receive.
In their first look at prescription drug use, Dartmouth researchers also find that the health status of a region's Medicare population accounts for less than a third of the variation in total prescription drug use, and that higher spending is not related to higher use of proven drug therapies. The study raises questions about whether regional practice culture explains differences in the quality and quantity of prescription drug use.
"There is no good reason why heart attack victims living in Ogden, Utah, are twice as likely to receive medicine to lower their cholesterol and their risk of another heart attack than those in Abilene, Texas, but this inconsistency reflects the current practice of medicine in the United States," said Jeffrey C. Munson, M.D., M.S.C.E., lead author and assistant professor at The Dartmouth Institute for Health Policy & Clinical Practice.
"This report demonstrates how far we still have to go as a nation to make sure people get the care they need when they need it," said Katherine Hempstead, Ph.D., M.A., senior program officer at the Robert Wood Johnson Foundation, a longtime funder of the Dartmouth Atlas Project. "Instead of varying widely, patterns of care should be nearly uniform across the country for non- controversial drug therapies with a strong evidence for their use."
The new report offers an in-depth look at how prescription drugs are used by Medicare beneficiaries in the program's Part D drug benefit, which had 37 million enrollees in 2012. The report separates the country into 306 regional health care markets and examines variations among them in the quantity and quality of prescription drug use, spending, and use of brand name drugs. To examine the quality of care, the report looks at prescription use in three categories:
Drug therapies proven to be effective for patients who have suffered heart attacks, have diabetes, or have broken a bone;
Discretionary medications, which have less clear benefits, but may be effective for some patients who take them; and
Potentially harmful medications, for which risks generally outweigh benefits.
"We need to learn from regions that consistently provide high-quality care, and focus attention on regions that appear to offer the worst of both worlds: high-risk and discretionary medications and, in relative terms, low use of effective drug therapies," said Nancy Morden, M.D., M.P.H., report co- author and associate professor at The Dartmouth Institute for Health Policy & Clinical Practice. "This will help us understand and ultimately improve prescribing quality for all Medicare beneficiaries."
Total use of prescription medications
The average Medicare Part D patient filled 49 standardized 30-day prescriptions in 2010. At the high end, patients in Miami, filled an average of 63 prescriptions, compared to patients in Grand Junction, Colo., who filled 39 prescriptions per year. Other high-use regions included Lexington, Ky., (59 prescriptions) and Huntington, W.Va., (58), compared to low-use regions in Albuquerque, N.M., (40) and San Mateo County, Calif. (41).
Use of effective prescription care
The report examines the use of proven drug therapies, including the use of beta blockers and statins in the months after a heart attack and the use of osteoporosis drugs after bone fractures.