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Prescription Drug Use in Medicare Part D

Prescription drugs represent a growing and diverse component of health care. Some medications can reduce the burden of illness or improve quality of life for many patients. Other drugs are less consistently effective, and all drugs have some potential for toxicities. It is therefore important to know how well prescribers in different regions of the country strike the balance between providing care that patients need while minimizing the use of drugs that are unnecessary or potentially harmful.

Expanding upon a construct established in prior Atlas work, prescription drugs can be divided into three broad categories: drugs that are effective in most patients at preventing or treating significant clinical outcomes; discretionary medications that require individuals to consider carefully the likelihood of uncertain benefits against potential risks or costs; and potentially harmful medications that have unfavorable risk-benefit tradeoffs for specific patients such as the elderly. Variation in effective drug use highlights regions that should serve as national benchmarks of quality prescribing as well as regions where targeted interventions and increased accountability are necessary to address a critical disconnect between evidence and practice. Variation in the use of high-risk medications provides an additional objective indicator of prescribing performance by identifying regions where physicians needlessly overuse risky medications. Lastly, variation in discretionary medication use demonstrates how physicians and patients respond to clinical uncertainty and highlights the importance of shared decision-making.




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The Dartmouth Atlas of Health Care is based at The Dartmouth Institute for Health Policy and Clinical Practice and is supported by a coalition of funders led by the Robert Wood Johnson Foundation, including the WellPoint Foundation, the United Health Foundation, the California HealthCare Foundation, and the Charles H. Hood Foundation.