A recent trial comparing medical and surgical management of elderly patients with coronary artery disease reported improved quality of life at one year for both treatment arms (Pfisterer, Buser et al. 2003), suggesting that treatment likely reduces disability in the elderly population. However, no studies to date have estimated the effect of increased use of appropriate pharmaceutical treatments over time on disability rates in the elderly population.
Pharmaceutical use is not captured in Medicare claims, since Medicare does not pay more for use of pharmaceuticals. Thus, we do not have time series data on the use of pharmaceuticals by area. We do have a snapshot of data on pharmaceutical use, taken from a survey of medical records in the mid-1990s. The cooperative Cardiovascular Project (CCP) abstracted medical record data on 186,800 Medicare patients hospitalized for an AMI between February 1994 and July 1995 including data on appropriateness for and receipt of guideline recommended treatments (Marciniak, Ellerbeck et al. 1998).
Use among patients most suited for treatment ranged from 51% for beta-blockers in the immediate post-myocardial infarction treatment to 76% for aspirin. Average utilization rates for the mid-1990s are shown in table 4. Researchers at Dartmouth have calculated the average use rate of each of these pharmaceuticals at the HRR level, which we employ in our analysis (O’Connor, Quinton et al. 1999).
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