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Libraries Unlimited. Need Help? Try our Search Tips. Award Winner. Leon and G. Rust originated the study. Leon conducted the literature review, synthesized data analysis, and led the writing. Moore prepared and analyzed the data. McDonald assisted with data interpretation and played a major role in writing and revisions. Rust supervised the study's implementation.
All authors helped to conceptualize ideas, interpret findings, and review drafts of the article. We explored possible disparities in seasonal influenza treatment in Georgia's disabled Medicaid population. Medicaid claims were analyzed from 69 clients with disabilities enrolled in a Georgia Medicaid disease management program. There were patients who met inclusion criteria i. Roughly one third Antivirals were used in only Treatment rates were nearly 3 times higher for White patients Our analysis suggests limited use of antiviral treatment of influenza overall, as well as significant racial disparities in treatment.
Influenza is a highly contagious viral disease of the respiratory system. It can lead to serious complications and can result in death. Influenza can be prevented with annual immunizations, and it can be effectively treated with disease-modifying antiviral drugs if diagnosed within 48 hours of initial symptoms. Rates of influenza immunization vary across racial and ethnic populations.
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Data from the National Immunization Survey NIS —Adult for the — season show influenza immunization coverage for those aged 18 to 49 years among Factors contributing to lower rates of immunizations among different races and ethnicities include limited access to health care, personal beliefs, and anticipated negative side effects. Additional reasons include feared side effects of the immunization, including the possible acquisition of influenza as a result of the vaccination. Those African Americans who were more receptive to receiving an annual influenza immunization were of a higher income and had a greater perception of susceptibility to influenza.
The widespread existence of racial and ethnic health disparities has been well documented and remains a national public health concern. Treatment of influenza within the first 48 hours reduces both the recovery time and the severity of the illness. With the threat of an influenza pandemic occurring at any time, it is a public health priority to assess potential treatment disparities, especially in those most susceptible to contracting influenza. Studying Medicaid claims data is useful because patients under Medicaid all have the same health insurance, as well as the same prescription coverage for medication.
The study used Medicaid claims data for non-Medicare nondual; i.
Disparities in Influenza Treatment Among Disabled Medicaid Patients in Georgia
The National Center for Primary Care at Morehouse School of Medicine works with this disease management program to identify opportunities to improve care and outcomes for this vulnerable segment of the Medicaid population. For these and similar analyses, personal identifiers are stripped from the data and stored in a secure and confidential manner.
These Medicaid data include both personal demographic information as well as records of each individual claim submitted to the state Medicaid program. The nondual non-Medicare segment of the adult aged, blind, or disabled population is automatically enrolled in disease management programs unless the client specifically opts out. At the time of the study, to data files were the most recent data available.
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The sample did not include those covered by Medicare or those who were in a nursing home or hospice care. The study sample was drawn from the Georgia Enhanced Care program, the only disease management program serving this non-Medicare, noninstitutionalized, aged, blind, or disabled segment of the Georgia Medicaid population residing in the northern third of Georgia.
It is important to note that these patients have high rates of comorbid conditions and are therefore highly vulnerable to the complications of influenza.
For example, according to Valdez et al. The study sample was limited to GEC individuals aged 18 to 64 years who had any diagnosis of influenza using International Classification of Diseases, Ninth Revision, Clinical Modification, code National Drug Codes were used to identify the main outcome variable, which was the prescription of a disease-modifying antiviral drug. Of note, beginning with the — influenza season, the CDC recommended not using rimantidine and amantadine, because of the high levels of resistance to these drugs among circulating influenza viruses.
It should be noted that the Georgia Medicaid program did not cover influenza vaccinations for a substantial part of the study period. We were therefore unable to determine whether those who were diagnosed with influenza had received an influenza immunization. Race was entered as a categorical variable, whereas gender and geography were entered as dichotomous variables.
Finally, multivariate adjusted odds ratios for receiving disease-modifying antiviral drugs were calculated. All analyses were conducted using SPSS version For calendar years and , claims data were filed for 69 patients.
Of these patients, 51 were aged between 18 and 64 years. From these patients, we focused on those diagnosed with influenza; for a total of patients patients in and patients in In total, unique patients met the inclusion criteria; some patients were diagnosed with influenza both years. Unfortunately, the number of patients in groups other than non-Hispanic White and non-Hispanic Black was too small for statistical analysis, which meant we were unable to analyze the data by ethnicity.
Of those with a diagnosis of influenza, only 75 Whereas African Americans accounted for about one half of the urban population Compared with African Americans, Whites were 2. All variables were included in the model simultaneously. Our results suggest 2 important findings. First, the prescribing of influenza antiviral medications was limited overall. Reasons for this remain unclear. Possible reasons for underutilization in general include poor drug supply, lack of provider knowledge about the availability and use of influenza antiviral medications, provider practices, medication costs, delay in seeking care by patients, and limited access to health care services for acute illnesses.
As mentioned earlier, influenza must be treated within the first 48 hours of experiencing symptoms. Although the first 48 hours are a critical time, many patients do not visit a doctor until later, if at all. One important reason for this is that many US residents do not have a primary source of health care. Instead, these individuals only have access to the emergency department, which often results in visits that may take hours before being seen.
For the patients in our study, there may exist a racial disparity in the propensity to seek early care after illness onset, which could be due to a suspicion of the health care system, lack of knowledge of treatment availability, or other factors such as transportation. Second, the data reveal a nearly 3-fold racial disparity in the treatment of influenza with disease-modifying antiviral drugs among disabled Medicaid patients.
Reasons for this disparity are unclear and merit further study to determine possible contributing factors. Blumenshine et al. The results of this study cannot completely be interpreted without examining the economic context of the patients' lives.
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It is important to note that the eligibility threshold for the program is set by Georgia Medicaid. These Georgia Medicaid income-eligibility requirements apply to both African Americans and Whites, as well as all other Georgia residents. The disparity we found raises important questions for both seasonal influenza management and effective pandemic influenza planning.
Given the heavy toll of seasonal influenza on the nation's health, 1 — 3 ensuring equitable treatment is of paramount importance. If disparities in influenza treatment can be present during the relative calm of seasonal influenza, heightened problems may reasonably be expected to occur in a pandemic. Pandemic planning needs to take this into account and anticipate possible challenges in providing antiviral treatment in an equitable fashion.
Those responsible for planning the response to an influenza pandemic cannot assume equal access to treatment modalities among all populations and must therefore plan accordingly.
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Our results should be interpreted in the context of the study's limitations. First, we did not have access to medical records or to direct personal interviews. Diagnosis of influenza is often a presumptive diagnosis not confirmed by viral culture at the clinical level. This diagnosis may or may not be used on the billing claim, and so episodes of influenza coded as fever or nonspecific viral illness or upper respiratory infection would not be captured in these data.
Similarly, if patients received drug samples for antiviral treatment, this would not be captured in the pharmacy claims data. These limitations would usually apply to persons of all racial groups who had the same Medicaid coverage, drug formulary, etc. On the other hand, because Medicaid claims are closely audited, the drug data that are included are considered to among the highest-quality data available on drug exposure.
Although the receipt of an annual influenza immunization may decrease an individual's chances of acquiring influenza, the study population did not have access to Medicaid-covered influenza immunizations during the entire study period, as noted above. A second limitation is the lack of data on the percentage of those diagnosed with influenza who presented within 48 hours of symptoms.
As noted earlier, a late diagnosis of influenza precludes effective treatment with antivirals.