Geographic Variation in the Quality of Prescribing

To assess U.S. geographic variation in the management of medication in elderly patients, the authors examined performance on two quality measures: the use of medications considered to be high-risk for the elderly and potentially harmful drug–disease interactions. Medicare spending on pharmaceuticals varies substantially among U.S. localities and hospital-referral regions, even after adjustment for variation in demographic characteristics, individual health status, and insurance coverage. 1 If the drugs that are prescribed in high-spending regions are necessary and appropriate, the high spending may be justified by the health improvement they generate. But if such prescribing is not appropriate, the higher use could have serious adverse consequences. The elderly are twice as likely as people under 65 years of age to have adverse events associated with drugs and almost seven times as likely to be hospitalized as a result. 2 Although we . . .