ABSTRACT
OBJECTIVES: Prior to the implementation of Medicare Part D in the United States, inequalities were found to exist in the use of medications between minority and white beneficiaries. Despite improvements in medication affordability after Medicare Part D implementation, it is still not clear whether the characteristics of the program have improved drug utilization patterns among minorities to the same degree as whites. This review aims to determine whether there were barriers for Medicare Part D to realize its potential to improve prescription drug utilization patterns among minorities. METHODS: Google Scholar, PubMed, Sciencedirect and Scopus were used to conduct a comprehensive search of the literature published since 2003 when the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was passed, which authorized the establishment of the Part D program. All studies and documents related to the effects of Medicare Part D on minorities were included to present a relatively comprehensive review on the topic. RESULTS: Evidence indicated that minorities are not equally benefiting from Medicare Part D prescription drug coverage compared to whites. Examples of characteristics of Medicare Part D that caused significant racial differences in drug utilization include the donut hole, the complexity and number of drug plans, and drug utilization management strategies. CONCLUSION: Medicare Part D has increased access to prescription medications for the elderly. However, continued analysis and research of drug utilization patterns among minorities should be conducted to ensure that all enrollees regardless of race are benefiting equally from Medicare Part D. Identification of these barriers can provide insights on how to improve the program to allow minorities to benefit equally from the Medicare Part D program and remove health inequalities.
ABSTRACT
BACKGROUND: Prevalence studies estimate that chronic constipation affects 12%-19% of Americans. This prevalence rate exceeds that of many highly publicized chronic conditions, including diabetes and asthma. Identifying the etiology of each patient's constipation is essential for determining treatment and management plans. The etiology of chronic constipation falls into 2 broad categories: primary or idiopathic constipation caused by physical and functional problems, and secondary constipation resulting from a variety of organic conditions as well as the use of certain medications. Patients may have more than one cause of their constipation. Treatment options may be based not only on the cause but may be dictated by a patient's health care coverage and the inclusion criteria of different health care plans. OBJECTIVES: To (a) present key information on the causes, diagnosis, and treatment recommendations for patients with chronic constipation; (b) describe how chronic constipation impacts quality of life; and (c) describe how all providers can work to improve the quality of care and health outcomes for patients with chronic constipation. SUMMARY: Chronic constipation is a prevalent condition that disproportionately affects women and the elderly. Most agents are available over-the-counter, although their efficacy has not been extensively tested. Few prescription agents are currently available, and they are more costly; therefore, managed care plans may restrict these products for patients who fail traditional treatments. A lack of evidence-based algorithms leaves many providers to treat patients empirically. Practitioners can assist patients seeking recommendations and provide information on treatment options.
