Daniela Koller, Tammy Hua, and Julie P. W. Bynum
D. Koller, T. Hua, and J. P. W. Bynum, “Treatment Patterns with Antidementia Drugs in the United States: Medicare Cohort Study,” Journal of the American Geriatrics Society, published online June 24, 2016.
Despite the devastating consequences of Alzheimer’s disease, there are very few options for managing its symptoms. The two classes of drugs most commonly used are expensive and often of limited benefit to patients, particularly in the later stages of the disease. Commonwealth Fund–supported researchers examined Medicare data to determine variations in prescribing by provider type, region, and stage of disease, among other variables.
Contrary to expectations, the authors found that newly diagnosed patients were treated with medication less often than patients in the later stages (49% vs. 61%). They also found wide variation in medication use across the United States, with the lowest rates in The Bronx, New York (32%) and the highest in Wausau, Wisconsin (66%). Overall, slightly more than half (55.8%) of patients with dementia in the U.S. received medication.
Compared with primary care physicians, neurologists and psychiatrists were more likely and geriatricians less likely to prescribe medication. Factors not directly related to disease, such as race, also influenced prescribing patterns. The researchers found African Americans were less likely and Asian and Hispanic patients more likely than whites to receive a prescription.
The wide variation suggests a lack of consensus on the value of these medications. It will be important to resolve these differences to ensure that providers—particularly primary care physicians, who see the majority of Alzheimer’s patients—follow best practices.