A recent Dartmouth Atlas Project report that highlights regional differences for prescription drug use among Medicare patients across the U.S. provides insights into best practices related to effective and high-risk prescription drug therapy.
The report [PDF] found geographic disparity in the total use of prescription medications, variations in effective prescription care, dissimilarities in the use of potentially harmful medications, and differences in total spending on prescription drugs.
Lead author Jeffrey Munson, MD, MSCE, says he expected some geographic variation in the use of discretionary medications, but was surprised by the discrepancy in patients' medication usage. For example, in San Angelo, Texas, 91.4% of heart attack survivors in 2008–2009 filled at least one prescription for beta blockers in the year after their discharge, compared with just 62.5% of the same population of patients in Salem, Ore.
"Clearly, there are regions of the country that have figured out how to best handle certain aspects of medication usage," says Dr. Munson, assistant professor at the Dartmouth Institute for Health Policy & Clinical Practice in Lebanon, N.H. "Instead of just looking at regions that are high performing and saying, 'Wow, that seems to be a really high bar they've set, I'm not sure we can achieve it,' I wonder if maybe it's time we look at those regions and say, 'How are you achieving those very high standards, and what about what you do can I do where I live.'"
The Dartmouth Atlas Project report documents geographic variation in healthcare utilization unrelated to outcome and offers an extensive database for comparison by state, county, region, and facility. Dr. Munson says he understands that healthcare reform is pushing hospitalists and other physicians to focus on many new issues, but that medication usage by patients is among the most pressing issues in healthcare.
"I know that everybody is under increasing time pressures," he adds, "but it’s hard to imagine a larger problem than not getting people the drugs they need to prevent really significant clinical outcomes."