- Title Information
- Title
- Elucidating the Role of Patients, Providers, and Policies in Predicting (mis)Use of High Risk Prescription Medications
- Name:
Personal
- Name Part
- Qato, Danya Mazen
- Role
- Role Term:
Text
- creator
- Origin Information
- Copyright Date
- 2014
- Physical Description
- Extent
- xii, 79 p.
- digitalOrigin
- born digital
- Note
- Thesis (Ph.D. -- Brown University (2014)
- Name:
Personal
- Name Part
- Dore, David
- Role
- Role Term:
Text
- Director
- Name:
Personal
- Name Part
- Trivedi, Amal
- Role
- Role Term:
Text
- Reader
- Name:
Personal
- Name Part
- Mor, Vincent
- Role
- Role Term:
Text
- Reader
- Name:
Corporate
- Name Part
- Brown University. Health Services Research
- Role
- Role Term:
Text
- sponsor
- Genre (aat)
- theses
- Abstract
- Pharmaceutical policy interventions are often promulgated with the implicit assumption that responsiveness is uniform across all patient groups in the population. The purpose of the three chapters of my dissertation was to challenge this assumption by exploring the consequences of policy changes on utilization patterns of drugs with important adverse effects, and investigating how sociodemographic factors and disparities in healthcare provision may influence such patterns of use.
In the first study, I utilized Medicare fee-for-service prescription, inpatient, and outpatient healthcare claims linked to Census data to investigate whether there exist racial, demographic, and socioeconomic differences in rates of discontinuation of the diabetes medication rosiglitazone after the issuance of a safety warning by the Food and Drug Administration. I employed survival analysis techniques and found that the warning effectively encouraged the majority of current users to discontinue rosiglitazone. However, certain segments of the population appeared more responsive and discontinued systematically earlier, most notably black enrollees, younger enrollees, and enrollees with no history of low personal income.
In the second study, using commercial pharmacy and healthcare claims, I employed a difference-in-difference research design to evaluate the impact of state level expansion of scope-of-practice prescriptive authority to nonphysician clinicians on utilization patterns of schedule II opioid pain relievers (OPRs). I found no evidence of a meaningful increase in utilization of schedule II OPRs attributable to the change in state policy, suggesting that expansion of prescribing privileges to nonphysicians may not result in unfettered use of the highly addictive opioid medications.
In the third study, I examined predictors of receipt of high risk medications (HRM) in a national sample of elderly, Medicare Advantage enrollees, utilizing a quality indicator developed by the National Council on Quality Assurance. In addition to gender, I found that region of residence was the strongest predictor of receipt of HRMs with substantial geographic variation in use of HRMs nationally.
By illuminating the presence and scope of geographic and sociodemographic differences in HRM use, the three chapters of my dissertation aim to encourage the refinement of policy efforts to improve the quality of drug prescribing nationally, especially for vulnerable populations.
- Subject
- Topic
- high risk medications
- Subject
- Topic
- inappropriate drug use
- Subject
- Topic
- drug risk management
- Record Information
- Record Content Source (marcorg)
- RPB
- Record Creation Date
(encoding="iso8601")
- 20141006
- Language
- Language Term:
Code (ISO639-2B)
- eng
- Language Term:
Text
- English
- Identifier:
DOI
- 10.7301/Z05T3HT0
- Access Condition:
rights statement
(href="http://rightsstatements.org/vocab/InC/1.0/")
- In Copyright
- Access Condition:
restriction on access
- Collection is open for research.
- Type of Resource (primo)
- dissertations