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Published Online, 18 May 2004, www.theannals.com, DOI 10.1345/aph.1D569.
 The Annals of Pharmacotherapy: Vol. 38, No. 7, pp. 1317-1318. DOI 10.1345/aph.1D569
© 2004 Harvey Whitney Books Company.
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Impact of healthcare delivery system on where HMO-enrolled seniors purchase medications

Denise M Boudreau, PhD

Research Associate Center for Health Studies Group Health Cooperative 1730 Minor Avenue Seattle, Washington 98101-1448 fax 206/287-2871 boudreau.d{at}ghc.org

Mark P Doescher, MD MPH

Associate Professor Department of Family Medicine University of Washington SeattleBarry G Saver MD MPH Associate Professor Department of Family Medicine University of Washington

J Elizabeth Jackson, MA

Research Assistant Department of Family Medicine University of Washington

Paul A Fishman, PhD

Scientific Investigator Center for Health Studies Group Health Cooperative

Published Online, May 18, 2004. www.theannals.com, DOI 10.1345/aph.1D569

TO THE EDITOR: For research and other purposes, it is essential that pharmacy utilization data captured in automated information systems in health maintenance organizations (HMOs) are complete.1 Generally, pharmacy utilization is captured only for enrollees who fill prescriptions at HMO pharmacies and for enrollees with a drug benefit through the HMO who fill prescriptions at contracting pharmacies. Drug benefit status and type of delivery system influence where medications are obtained and therefore affect whether pharmacy utilization is captured in the database.2 Understanding where HMO enrollees obtain medications is useful for research, such as determining study populations and evaluating possible drug exposure misclassification. We report the source of prescription medications for seniors enrolled in Group Health Cooperative (GHC), with and without a drug benefit, and receiving care within a closed group or network model delivery system.

Methods. We surveyed subjects aged ≥67 years enrolled in GHC's Medicare + Choice program during 1998–1999 who were diagnosed with one or more chronic conditions including hypertension, diabetes, congestive heart failure, and coronary artery disease. Subjects without a drug benefit through GHC, persons dually enrolled in Medicare and Medicaid, and persons expected to be less affluent (geocoding addresses to census block groups) were over-sampled.3 Nursing home residents and persons with dementia, psychosis, or cancer not in remission for at least 5 years were excluded. Our final sample (n = 4257) included subjects with completed surveys, consent to examine automated data, self-reported current prescription medication use, and self-reported medication source(s). Prescription medication sources (GHC–owned pharmacy, community pharmacy, mail-order, Internet, hospital, international, other) were collapsed into 3 groups: GHC pharmacies, GHC and non–GHC pharmacies, and non–GHC pharmacies. Non–GHC pharmacies include pharmacies contracting with GHC.

Results. The proportion of seniors who reported obtaining medications exclusively at GHC pharmacies was 91.2% of those with a drug benefit in the closed group model, 78.3% of those without a drug benefit in the closed group model, 6.9% of those with a drug benefit in the network model, and 16.3% of those without a drug benefit in the network model (Table 1).


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  		Table 1. Source of Prescription Medications and Subject Characteristics by Drug Benefit Status and Type of Healthcare Delivery System

 

Discussion. This study demonstrates that seniors' choice of source for prescription medications is influenced by drug benefit status and type of healthcare delivery system. Seniors with a drug benefit who receive care in a closed group model delivery system are most likely to obtain medications exclusively at HMO pharmacies.

Our study has several limitations. Subjects were seniors from a single HMO in Washington State and do not represent seniors across the US. Self-reported data were not validated. Lastly, price incentives offered by pharmacies could not be analyzed and may explain why seniors without a drug benefit in the network obtained medications at GHC pharmacies.

Limitations notwithstanding, researchers can apply our results as a guide for the level of completeness that can be expected from automated pharmacy data. Further research is needed in younger populations and in determining the completeness of HMO pharmacy data in different research scenarios by benefit status and type of delivery system.

ADDENDUM: Corrections to this article, subsequent to its May 18, 2004, online posting, were deletion of "Overall, 75% of subjects reported obtaining medications exclusively at GHC pharmacies," which had preceded the first sentence in the "Results" section, and deletion of "Total, n (%)" columns in Table 1.

References

  1. West SL, Strom BL, Poole C. Validity of pharmacoepidemiology drug and diagnosis data. In: Strom B, ed. Pharmacoepidemiology. 2nd ed. Chichester: John Wiley & Sons, 2000:661 -705.
  2. Shatin D. Organizational context and taxonomy of health care databases. Pharmacoepidemiol Drug Saf 2001;10:367-71.[Medline]
  3. Saver BG, Doescher MP, Jackson JE, Fishman PE. Seniors with chronic health conditions and prescription drug: benefits, wealth, and health.Value in Health 2004;7(2):133 -43.



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