Evidence map›Paper›PMID 34933870›Full record

ArticleBMJ open diabetes research & care2021

Changes in diabetes prescription patterns following Affordable Care Act Medicaid expansion.

Jordan Gemelas, Miguel Marino, Steele Valenzuela, Teresa Schmidt, Andrew Suchocki, Nathalie Huguet

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open diabetes research & care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02685384 (Post ACA Reform), which is not on this map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
1.8field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02685384 completednot on this map

Post ACA Reform: Evaluation of Community Health Center Care of Diabetes

TypeobservationalSponsorOregon Health and Science UniversityRan2012 to 2021Enrolled1,938,375ConditionsDiabetes Mellitus (DM)ArmsMedicaid Expansion
3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 7 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 1 country.

Jordan GemelasDepartment of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA gemelas@ohsu.edu.ORCID 0000-0002-9219-9314
Miguel MarinoDepartment of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Steele ValenzuelaDepartment of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Teresa SchmidtResearch Department, OCHIN, Portland, Oregon, USA.
Andrew SuchockiClackamas County Health Clinics, Oregon City, Oregon, USA.
Nathalie HuguetDepartment of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Oregon Health & Science University · USPortland State University · USClackamas Community College · USOchin · US

Funding

PREVENT-D: Post ACA Reform: Evaluate Community Health Center Care for DiabetesU18DP006116 · DP · OREGON HEALTH & SCIENCE UNIVERSITY · PI HUGUET, NATHALIE · 2015 to 2019
$2.2M
NCCDPHP CDC HHS U18 DP006116
6 · The paper itself

Abstract

introductionMost patients with diabetes mellitus are prescribed medications to control their blood glucose. The implementation of the Affordable Care Act (ACA) led to improved access to healthcare for patients with diabetes. However, impact of the ACA on prescribing trends by diabetes drug category is less clear. This study aims to assess if long-acting insulin and novel agents were prescribed more frequently following the ACA in states that expanded Medicaid compared with non-expansion states. RESEARCH DESIGN AND

methodsIn this analysis of a natural experiment, prescriptions reimbursed by Medicaid (US public insurance) for long-acting insulins, metformin, and novel agent medications (DPP4 inhibitors, sodium/glucose cotransporter 2 inhibitor antagonists, and glucagon-like peptide-1 receptor agonists) from 2012 to 2017 were obtained from public records. For each medication category, we performed difference-in-differences (DID) analysis modeling change in rate level from pre-ACA to post-ACA in Medicaid expansion states relative to Medicaid non-expansion states.

resultsExpansion and non-expansion states saw a decline in both metformin and long-acting insulin prescriptions per 100 enrollees from pre-ACA to post-ACA. These decreases were larger in non-expansion states relative to expansion states (metformin: absolute DID = +0.33, 95% CI=0.323 to 0.344) and long-acting insulin (absolute DID: +0.11; 95% CI=0.098 to 0.113). Novel agent prescriptions in expansion states (+0.08 per 100 enrollees) saw a higher absolute increase per 100 Medicaid enrollees than in non-expansion states (absolute DID= +0.08, 95% CI=0.079 to 0.086).

conclusionsThere was a greater absolute increase for prescriptions of novel agents in expansion states relative to non-expansion states after accounting for number of enrollees. Reducing administrative barriers and improving the ability of providers to prescribe such newer therapies will be critical for caring for patients with diabetes-particularly in Medicaid non-expansion states.

Indexed as

Diabetes MellitusPatient Protection and Affordable Care ActBlood GlucoseHumansMedicaidPrescriptionsUnited StatesBlood Glucosedrug utilizationhealth policyprimary health care

Identifiers

PMID34933870
PMCPMC8679078
OpenAlexW4200558595

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.