Clinical study
Health care and medication costs and use among older adults with heart failure

https://doi.org/10.1016/j.amjmed.2003.11.016Get rights and content

Abstract

Background

Heart failure disproportionately affects older adults for whom multiple medications are prescribed to prevent exacerbations and hospitalization. To target interventions effectively, it is important to understand the association of medication acquisition with health care utilization and costs.

Methods

We used electronic medical records from an urban public health care system to identify patients aged ≥50 years who had a diagnosis of heart failure. We assessed the association between inappropriate or appropriate medication supplies and hospitalization and costs using multivariable analyses that adjusted for demographic characteristics, prior health care use, health status, and insurance status.

Results

Total health care costs for treating 1554 patients with heart failure from 1996 to 2000 were $36.6 million (in 2000 dollars). Less than a third of patients received appropriate medication supplies (between 90% and 110% of the supplies needed) annually. Compared with patients with appropriate supplies, the odds of hospitalization were greater among those with undersupplies (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 2.3 to 4.2; P <0.0001) or oversupplies (OR = 2.0; 95% CI: 1.7 to 2.4; P <0.0001). Total costs were 25% higher for patients with undersupplies (95% CI: 8% to 46%; P = 0.004) and 18% higher for those with oversupplies (95% CI: 7% to 30%; P = 0.0009) than for those with appropriate supplies.

Conclusion

Among adults with heart failure, inappropriate medication supplies were associated with increased hospitalization and higher costs. Monitoring medication supplies from electronic medical records may be a useful component of programs aiming to improve care while managing costs.

Section snippets

Study site

The study site was Wishard Health Services, a tax-supported, public health care system in Indianapolis, Indiana, which includes a 300-bed hospital, emergency department, adjacent ambulatory practices, and citywide network of community-based health care centers. Physicians are faculty of the Indiana University School of Medicine. Wishard pharmacies are located centrally and within the community-based centers, and function under a closed formulary. Electronic medical records from Wishard are

Results

We identified 1554 patients who met our inclusion criteria during the study period (Figure 1). Patients (Table 1) were followed for a mean (± SD) of 2.7 ± 1.5 years, and 356 (23%) died during the study period. About 725 patients received cardiovascular medications annually, of whom 306 (42%) were hospitalized. During the study period, total direct health care costs were nearly $36.6 million, with inpatient costs comprising more than $19 million (52%) of total health care costs. Outpatient

Discussion

We found that only 31% of patients received appropriate supplies of cardiovascular medications (between 90% and 110% of the supplies needed annually). Although we examined medication supplies rather than patient compliance, our results are consistent with previous research that found that patients are typically 40% to 50% compliant with their medication regime 16, 17, 27, 28. In the present study, increasing undersupplies and oversupplies of medications were associated with greater

Acknowledgements

The authors thank Beverly Clark for her assistance in the preparation of this manuscript.

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    Support for this project was funded in part by the National Institute on Aging (AG19105 and AG07631), Bethesda, Maryland, and the National Heart, Lung, and Blood Institute (HL69399-01), Bethesda, Maryland. The views expressed are solely the authors'.

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