Some Americans not getting the right medications
Most cardiologists give patients who’ve had heart attacks certain prescription drugs like beta-blockers and statins, but exactly which drug you get could depend on where you live.
A new study released Tuesday, published by the Dartmouth Atlas project, found that some medications are prescribed significantly more in certain regions of the U.S. than others, which further reveals just how complex, confusing and out-of-control America’s health care system has become.
According to researchers involved with the study, more than 1 in 4 adults on Medicare's prescription drug plan had filled at least one prescription for drugs long considered high-risk.
For example, seniors living in Alexandria, Louisiana were over three times as likely as those living in Rochester, Minnesota to get prescriptions filled for potentially dangerous drugs, such as tranquilizers and muscle relaxers that are not only very sedating, but put them at risk for falls and other accidents common among the elderly.
Meanwhile, 91 percent of seniors living in Ogden, Utah who had survived a heart attack were filling prescriptions for cholesterol-lowering statin drugs, compared with only 44 percent of older heart attack survivors in Abilene, Texas – this, despite the fact that statins have been proven to lower the risk of having another heart attack.
The study also found that only 14 percent of older adults with a broken bone due to osteoporosis had received appropriate medications that have been proven to protect against another fracture.
“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 lead researcher Dr. Jeffrey Munson, an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice.
The Dartmouth Atlas, a project that evaluates differences and other changes in medical care across the nation, looked at 2010 prescriptions written for and filled by patients on Medicare, the federal health insurance plan for Americans over 65.
The researchers reviewed numerous kinds of prescription drugs, including blood pressure and cholesterol medications typically prescribed after a heart attack, as well as osteoporosis drugs for older people who have broken a bone. They also looked at prescribed drugs known to be dangerous for seniors – like Valium and other tranquilizers that are high risk for the elderly.
They expected to find consistent prescription rates for post heart attack and osteoporosis drugs, as the benefits of certain medications following a heart attack or broken bone have long been know – and, generally speaking, physicians agree that prescribing blood pressure and cholesterol lowering drugs to a patient who’s had a heart attack is wise.
Nevertheless, the research team found that 91 percent of heart attack patients in San Angelo, Texas in 2008 0r 2009 were prescribed a beta-blocker to lower blood pressure, whereas only 62.5 percent in Salem, Oregon were.
For cholesterol-lowering statin drugs, the rates ranged from 91 percent of patients in Ogden, Utah to 44 percent in Abilene, Texas – and the rates were lower everywhere for bone-building drugs used to protect against osteoporosis.
Anyone with osteoporosis who breaks a bone should receive drugs to stop the bone-thinning condition, according to the National Committee for Quality Assurance. However, the study found that only 14 percent of the Medicare patients with a broken bone received such medication.
“We found that regions with high use of beta blockers don’t necessarily have high rates of statin use,” Dartmouth's Dr. Nancy Morden in a conference call with reporters.
The Dartmouth Atlas researchers place the blame on physicians who prescribe the drugs.
“We are measuring the behavior of individual physicians,” Munson said. “Doctors everywhere should know the benefits of both statins and beta-blockers.”
A number of other studies have found major disparities in health among Americans. For example, people living in Colorado generally work out more and are thinner than people living in Mississippi, although the Dartmouth Atlas project did not find any clear correlation between those findings and prescription drug use.
On the other hand, one measure that did correlate with other medical care practices was the use of drugs known to be risky, such as such as muscle relaxants, benzodiazepines and antihistamines, all of which are sedating and can make people fall asleep.
Yet, the survey found that over 25% of Medicare patients filled a prescription for at least one of these drugs – and such drugs were most commonly prescribed in areas of the U.S. where the highly recommended medications were least likely to be prescribed.
“There was more than a threefold difference between the percent of patients treated with a high-risk medication in Rochester, Minnesota (14 percent) and the percent treated in Alexandria, Louisiana (43 percent),” the research team wrote.
“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, senior program officer at the Robert Wood Johnson Foundation, which helps fund the Dartmouth Atlas Projects.
SOURCE: The Dartmouth Institute, The Dartmouth Atlas of Medicare Prescription Drug Use (released October 15, 2013).