Expansion of U.S. ** coverage has led to dramatic increase in antibiotic use

Business Club, September 15th, August issue of the "Internal Medicine Literature", said that the use of antibiotics has increased in older Americans with increased prescription drug coverage. The US government’s Medicare Part D led to these The drug coverage of the elderly has expanded and the use of broad spectrum, newer and more expensive drugs has grown significantly.

"The excessive use of antibiotics is a common problem that may lead to unnecessary prescription drug expenditure, increase the risk of adverse reactions without related benefits, and produce drug resistance." The authors pointed out in the background information of this article. A number of plans aimed at reducing hospitalization and outpatient antibiotic misuse are already in progress. Although many interventions have reduced antibiotic prescriptions for acute respiratory infections and other symptoms, there is still room for further reductions in the use of antibiotics.

Some studies have shown that as the cost of medication increases, patients are less likely to get prescription drugs and medications for chronic illness prescriptions. To assess whether antibiotic use is similar, Dr. Zhang Yuting and colleagues at the University of Pittsburgh, United States, conducted a control group analysis of 35,102 elderly patients who had used antibiotics two years before and after the start of the Medicare Part D. It has been estimated in the past that this prescription drug coverage expansion can reduce 13% to 23% of the self-conceived expenditure.

The subject of this study was one of the following four groups: three intervention groups with no or limited coverage from 2004 to 2006, and one covered by uncapped stable drugs expended by employers during the four-year study period. Control group. In January 2006, all participants in the three intervention groups participated in Medicare Part D, and standard services included a deductible of US$250—25% of self-burden and catastrophic when drug spending reached US$2,250. Costs 2% of your own (drugs spent more than $5,100 or taking over $3,600).

"After the implementation of Medicare Part D, the cost of self-impairment decreased and the use of antibiotics increased," the authors write. Compared to the control group, the use of antibiotics increased the most among participants who had no drug coverage and switched to Medicare Part D.

In the case of pneumonia, the implementation of Medicare Part D has led to a three-fold increase in the rate of antibiotic treatment in individuals who have not previously been covered by drugs. Due to the high mortality rate of community-acquired pneumonia among the elderly, the finding that changes in coverage have increased the likelihood of treatment is encouraging. The author wrote.

“However, we also found that antibiotic use increased in the treatment of acute respiratory infections (sinusitis, pharyngitis, bronchitis, and non-specific upper respiratory tract infections) that are not usually used as indications of antibiotics.” The authors concluded that “research shows that Cost compensation does play a role in the inappropriate prescription and use of antibiotics."

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