Cost Sharing and the Initiation of Drug Therapy for the Chronically Ill

Purpose The purpose of this paper is to examine whether high-cost-sharing ambulatory care policies affect non-urgent emergency department (ED) care utilization differently among individuals with and without chronic conditions. Design/methodology/approach This retrospective cohort study used 2010–2011 US Medical Expenditure Panel Survey data. Difference-in-difference methods, multivariate logit model and survey procedures were employed. Time lag effect was used to address endogeneity concerns. Findings The sample included 4,347 individuals. Difference in non-urgent ED visits log odds between high- and low-cost-sharing policies was not significantly different between chronically ill and non-chronically ill individuals (β=−0.48, p=0.42). Sensitivity analysis with 15 and 25 percent cost-sharing levels also generated consistent insignificant results (p=0.33 and p=0.31, respectively). Ambulatory care incidence rates were not significantly different between high- and low-cost-sharing groups among chronically ill people (incidence rate ratio=0.849, p=0.069). Practical implications High-cost-sharing ambulatory care policies were not associated with increased non-urgent ED care utilization among chronically ill and healthy people. The chronically ill patients may have retained sizable ambulatory care that was necessary to maintain their health. Health plans or employers may consider low-level cost-sharing policies for ambulatory care among chronically ill enrollees or employees. Originality/value Findings contribute to insurance benefit design; i.e., whether high-cost-sharing ambulatory care policies should be implemented among chronically ill enrollees to maintain their health and save costs for health plans.

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Polypharmacy and drug misuse in elderly migrants: care practice and interprofessional collaboration

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.786 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

H Tezcan-Güntekin ◽

R Bird ◽

I Özer-Erdogdu

Keyword(s):

Drug Therapy ◽

Interprofessional Collaboration ◽

Language Barriers ◽

Chronically Ill ◽

Drug Misuse ◽

Care Practice ◽

Interprofessional Communication ◽

Increased Risk ◽

Elderly Migrants ◽

Health Application

Abstract Background Polypharmacy is associated with an increased risk of falls and adverse events in the elderly. Factors such as inappropriate infrastructure for resolving language barriers can make people with migration backgrounds more vulnerable to polypharmacy. This study aimed to assess barriers in the drug therapy of elderly migrants and to obtain input for an e-health application supporting medication management and interprofessional communication. Methods 10 expert interviews were conducted with health professionals working with chronically ill patients of Turkish descent. The sample included physicians, pharmacists, social workers and nursing professionals. The interviews were analyzed using structuring content analysis. Results Respondents perceived language barriers and discontinuities in medication prescription as key problems in the drug therapy of elderly migrants. Changes in the brand of medication prescribed were highlighted as particularly damaging to patient-provider relationships. Interprofessional communication was deemed important, with physicians and pharmacists expressing dissatisfaction in this area. Some respondents saw potential in the e-health application, while others cited concerns about data protection or the digital capabilities of elderly migrants. Conclusions Healthcare professionals may require support in providing information in a variety of languages. Additionally, more interprofessional collaboration is desired but it is necessary to first establish better channels of communication. An e-health application could help achieve clearer communication between stakeholders. However, it is necessary to work in close cooperation with professionals when designing the application to ensure that it can be implemented in practice. Key messages Language barriers and inconsistent prescription practices harm patient-provider relationships. Better channels of communication are needed to provide less fragmented care to elderly migrants.

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Polypharmacy in elderly migrants: perspectives of chronically ill migrants on E-Health-Applications

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.059 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

H Tezcan-Güntekin ◽

I Özer-Erdogdu

Keyword(s):

Drug Therapy ◽

Information Exchange ◽

Inappropriate Medication ◽

Medication Management ◽

Chronically Ill ◽

The Elderly ◽

Accessible Information ◽

Increased Risk ◽

Elderly Migrants ◽

Health Applications

Abstract Background Polypharmacy occurs frequently among the elderly and is associated with an increased risk of falls and medication-related adverse events. Especially people with migration backgrounds may receive inappropriate medication due to language barriers or experiences of discrimination in healthcare. This study aimed to assess barriers to drug therapy in elderly migrants and to generate user experience data for the development of an e-health application. Methods 10 interviews, respectively, with chronically ill individuals of Turkish descent and with family caregivers. The 20 interviews were analyzed qualitatively by means of structuring content analysis. Results Medication is connected to uncertainty for respondents and most are affected by polypharmacy. Medication is not always taken regularly, especially among respondents living transnationally. Adherence depends on trust and the quality of doctor-patient relationships. The number of medications required and their side effects are a source of dissatisfaction, but elderly migrants develop a variety of coping strategies. Smartphone use is common among respondents and they are open to using an application for medication prescription and intake management. Conclusions Interprofessional care teams are needed in order to reduce uncertainty regarding medication management, to improve health literacy and to strengthen alliances between stakeholders. Additionally, collaboration between diversity-sensitive nursing care specialists and physicians is needed to provide accessible information, thus improving continuity of intake and adherence. E-health applications have the potential to improve medication management and information exchange between all stakeholders, thus facilitating correct medication use. Key messages Diversity-sensitive care can improve drug therapy for elderly migrants by removing language, information and trust barriers. Elderly migrants are open to web-applications for medication management.

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