Potentially inappropriate medication use by Medicaid plus Choice beneficiaries in the last year of life

Background: Regardless of the payer and the period studied the prevalence of potentially inappropriate medication use in the elderly ranged from 21% to 40%. Objective: To look at potentially inappropriate prescribing in a group of Medicare + Choice beneficiaries in their last year of life (LYOL) in a large national managed care organization. Research design: Retrospective review of Medicare + Choice decedents' drug claims and enrollment data collected between January 1998 and December 2000, supplemented by the Medicare denominator file and 1990 Census data. Subjects: Four thousand six hundred two beneficiaries in a large national managed care organization. Measures: We analyzed the relationship between disagreement with the Beers' criteria and sociodemographic descriptors, insurance characteristics, and cause of death. We used logistic regression techniques to estimate factors associated with the disagreement. Results: Two thousand thirty-one beneficiaries (44%) had at least one claim in the LYOL that disagreed with a Beers' criterion, 15% experienced more than one unique Beers' disagreement. The most common disagreements were for the use of propoxyphene (15.0%), followed by zolpidem (3.8%), and amitriptyline (2.8%). Based on total claims, cancer patients were most likely to receive propoxyphene (35.3%) followed by patients with a heart condition (29.6%). A large proportion of the potentially inappropriate prescribing involves psychoactive rugs. The logistic model showed fewer Beers' criteria breaches associated with being male and being non-white. Beers' breaches were more common if the beneficiary has increasing prescription use or died from cancer. Conclusion: This study showed that many beneficiaries have prescriptions that contravene the Beers' criteria.