Study finds Rx therapies vary greatly by region

October 17, 2013

Whether a patient receives proven and effective medications or potentially harmful ones may depend on where they live, according to a report from the Dartmouth Atlas Project.

Whether a patient receives proven and effective medications or potentially harmful ones may depend on where they live, according to a report from the Dartmouth Atlas Project.

The report analyzed the drug therapies of Medicare patients across the country and found that location is a key factor in both the quality and cost of medical care patients receive.

“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 Jeffrey C. Munson, MD, MSCE, lead author and assistant professor at The Dartmouth Institute for Health Policy & Clinical Practice.  

The report examines prescription drug usage in the Medicare Part D program. Researchers separated the country into 306 markets and studied variations in the quantity and quality of prescription drug use, spending, and use of brand name drugs. Specifically, the report focuses on drug therapies proven to be effective for patients who have suffered heart attacks, have diabetes, or have broken a bone; discretionary medications that have less clear benefits but may be effective for some patients; and potentially harmful medications for which risks generally outweigh benefits.

For example, the report examined the use of beta-blockers and statins in the months after a heart attack. It found that 78.5% of patients filled at least one prescription for a beta-blocker in the seven to 12 months following a hospital discharge in 2008 or 2009.

But the rate varied greatly by region. In San Angelo, Texas, 91.4% of patients filled at least one prescription for a beta-blocker compared to 62.5% of patients in Salem, Oregon.  In a similar scenario, statin use ranged from 91.3% in Ogden, Utah to 44.3% in Abilene, Texas.

“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, PhD, MA, senior program officer at the Robert Wood Johnson Foundation, a funder of the Dartmouth Atlas Project. “Instead of varying widely, patterns of care should be nearly uniform across the country for non-controversial drug therapies with a strong evidence for their use.”

The report also found discrepancies when it came to potentially harmful medications, with patients in Alexandria, La., (43%) more than three times as likely to receive at least one high-risk medication as patients in Rochester, Minn. (14%).