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PubMedDate not supplied

Selected characteristics of senior citizens prescription drug payment and procurement in 1998 and 2001.

BACKGROUND: People without prescription drug coverage face greater financial burdens and may sometimes be unable to follow the courses of treatment prescribed by their physicians. The U.S. legislature is considering Medicare coverage for prescription drugs and the use of managed care approaches for containing costs associated with senior citizens. prescription drug therapy. OBJECTIVE: The purpose of this study was to describe selected characteristics of senior citizens. prescription drug payment and procurement. METHODS: Data were obtained via mailed survey from national random samples of senior citizens in 1998 and in 2001. Descriptive statistics and regression analyses were used to describe relationships among study variables. RESULTS: Of 2,434 deliverable surveys, 946 (39%) were returned. Of these, 700 (29%) respondents provided usable data for analysis. Results showed that in 2001, compared with 1998, the proportion of senior citizens without any prescription insurance coverage did not change significantly, 29% and 32%, respectively. However, the proportion of respondents with prescription drug coverage who had to share costs of prescriptions through copayments and coinsurance rose significantly, from 69% in 1998 to 89% in 2001. Between 1998 and 2001, the proportion of senior citizens using mail-order pharmacies rose significantly, from 17% to 27%, and the proportion who reported financial hardship also rose, from 19% in 1998 to 31% in 2001. Controlling for year, prescription drug use, and income, logistic regression analysis showed that respondents without any prescription insurance coverage were about 5 times more likely to report financial hardship compared with those having coverage. CONCLUSIONS: The proportion of senior citizens without any prescription drug insurance coverage did not change significantly between 1998 and 2001, but cost sharing in terms of the proportion that had cost-sharing requirements and the amount of the cost sharing through copayments and coinsurance rose significantly. Self-reported financial hardship and the use of mail-order pharmacies among seniors increased between 1998 and 2001.

Aged↗
PubMed1976

Reducing outpatient attendances.

Outpatient attendances can be reduced by indirect contact by letter and telephone; this frees the consultant to concentrate on patients attending for the first time. Such methods have not yet been fully exploited in the National Health Service.

Outpatient Clinics, Hospital↗
PubMed2005

Judgment processes in older adults' drug benefit evaluations.

BACKGROUND: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 will provide drug coverage to older adults through a variety of mechanisms, including stand-alone prescription drug benefits. Variation in cost-sharing and utilization controls is permitted, leading potentially to a wide variety of prescription benefit plans. However, little is known regarding the manner in which beneficiaries will integrate information to form plan evaluations. OBJECTIVES: The objectives of this study were to assess and compare the use of compensatory and configural judgment models in older adults' evaluations of drug benefit plans. METHODS: Three focus groups were conducted with a total of 19 seniors to elicit relevant drug plan attributes. A separate group of 32 seniors then judged the suitability of 48 drug benefit profiles based on these attributes. Within-subjects regression analysis was used to reveal each participant's judgment policy. RESULTS: Focus groups suggested that copayment, premium, deductible, formulary use, and mail-service use were relevant plan attributes. Regression analyses showed that while most participants used compensatory judgment models in evaluation formation, 12 (37.5%) subjects used conjunctive judgment models. CONCLUSIONS: Configural judgment processes are used frequently by older adults when evaluating drug benefit plans. Future research using more fine-grained techniques (eg, process tracing) might help further elucidate judgment processes in this context.

Aged↗
PubMed2001

Perceived work ability of home care workers in relation to individual and work-related factors in different age groups.

This study analysed the relationship between age and items of the Work Ability Index (WAI) among 19- to 62-year-old female home care workers (n = 636). The first significant decrease in work ability occurred between the ages of 40 and 44 years, and a second, sharper decrease occurred after 55 years of age. The subjects' physical work ability deteriorated as early as 35 years of age. In addition, current work ability, number of diagnosed diseases and work impairment due to diseases proved to be the most age-sensitive measures of work ability. The subjects who perceived their health status as poor had the highest risk for poor work ability. Moreover, the age-adjusted odds ratio indicated that the WAI was strongly associated with age and musculoskeletal and psychosomatic symptoms. Ergonomics, possibilities to control one's own work, time pressure and management were the features of work that predicted work ability. The study demonstrated the need to promote the work ability of home care workers early in working life. Among both older and younger workers, preventive measures should focus on the above-mentioned factors.

Adult↗
PubMedDate not supplied

Comparison of costs of community and mail service pharmacy.

OBJECTIVE: To compare the costs of prescriptions dispensed through mail service and community pharmacies to quantify the comparative costs of the two types of pharmacies. DESIGN: Modeling study based on 1-year of claims data from a cohort of patients. SETTING: A health plan in the northeastern United States. PATIENTS: Approximately 100,000 members of the health plan. INTERVENTION: The plan used a small pharmacy benefits manager (PBM) and a mail service pharmacy that was not owned by a major PBM, a three-tier benefit design, and specified that patients could get a 90-day supply through mail service for the equivalent of two 30-day community pharmacy copayments. MAIN OUTCOME MEASURES: Actual total, ingredient, plan, and patient costs of prescriptions dispensed through a mail service pharmacy and the estimated costs of those same prescriptions at community pharmacies. RESULTS: Total costs for the 44,847 prescriptions dispensed through mail service were dollar 6,401,624. Had these prescriptions been dispensed at community pharmacies, costs would have been dollar 6,902,252. Ingredient costs were dollar 6,401,624 through mail versus dollar 6,633,170 at community pharmacies. Total costs to the health plan were dollar 4,726,637 through mail versus dollar 4,417,733 at community pharmacies. Member costs were dollar 1,674,987 through mail versus dollar 2,484,519 at community pharmacies. CONCLUSION: Compared with community pharmacies, the mail service pharmacy was less expensive overall, less expensive for patients, but more expensive to the health plan. From the health plan's perspective, the loss of copayments in the mail service benefit was greater than the savings on ingredient costs and dispensing fees.

Adolescent↗
PubMed1997

Response rates to mail surveys published in medical journals.

OBJECTIVE: The purpose of this study was to characterize response rates for mail surveys published in medical journals; to determine how the response rate among subjects who are typical targets of mail surveys varies; and to evaluate the contribution of several techniques used by investigators to enhance response rates. METHODS: One hundred seventy-eight manuscripts published in 1991, representing 321 distinct mail surveys, were abstracted to determine response rates and survey techniques. In a follow-up mail survey, 113 authors of these manuscripts provided supplementary information. RESULTS: The mean response rate among mail surveys published in medical journals is approximately 60%. However, response rates vary according to subject studied and techniques used. Published surveys of physicians have a mean response rate of only 54%, and those of non-physicians have a mean response rate of 68%. In addition, multivariable models suggest that written reminders provided with a copy of the instrument and telephone reminders are each associated with response rates about 13% higher than surveys that do not use these techniques. Other techniques, such as anonymity and financial incentives, are not associated with higher response rates. CONCLUSIONS: Although several mail survey techniques are associated with higher response rates, response rates to published mail surveys tend to be moderate. However, a survey's response rate is at best an indirect indication of the extent of non-respondent bias. Investigators, journal editors, and readers should devote more attention to assessments of bias, and less to specific response rate thresholds.

Allied Health Personnel↗