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Racial disparities in access to medicines increase after implementation of prescription surveillance

BOSTON--Health policies designed to curb inappropriate medication prescribing can have the unintended effect of increasing racial disparities in access to appropriate care, reports a study by the Department of Ambulatory Care and Prevention (of Harvard Medical School and Harvard Pilgrim Health Care). The research, led by Dennis Ross-Degnan, ScD, associate professor in the Department of Ambulatory Care and Prevention, and Sallie-Anne Pearson, PhD, of the University of New South Wales, is reported in the March 13 Archives of Internal Medicine.

"This is the first well-controlled study to show that health policies designed to reduce drug costs and abuse can increase racial disparities in access to effective care for those with chronic illnesses, like schizophrenia," said Pearson.

The authors examined the effects of a prescription-monitoring program on access to benzodiazepines among nearly 125,000 Medicaid enrollees living in neighborhoods of different racial composition. Benzodiazepines are widely prescribed and effective treatments when used appropriately for anxiety, panic, sleep, and seizure disorders. They are also adjunct therapies for people with chronic mental illness, such as bipolar disorder and schizophrenia. However, there is controversy about their risk of dependency and abuse.

The New York program that monitors use of benzodiazepines reduced problematic use and almost completely eliminated benzodiazepine abuse including pharmacy hopping, in the cohort of Medicaid patients followed. Yet larger groups of vulnerable patients also showed reduced access to appropriate use of benzodiazepines as a result of the monitoring program. Blacks had a lower baseline rate of benzodiazepine use as compared to whites and Hispanics, but also had the greatest reduction in use as a result of the monitoring policy.

"These findings suggest that well-intentioned health policies can exacerbate racial disparities," Ross-Degnan said.

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Contact: Leah Gourley
public_affairs@hms.harvard.edu
617-432-0442
Harvard Medical School
13-Mar-2006


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