Person: Madden, Jeanne
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Madden
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Jeanne
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Madden, Jeanne
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Publication Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study(BMJ Publishing Group Ltd., 2014) Lu, Christine; Zhang, Fang; Lakoma, Matthew D; Madden, Jeanne; Rusinak, Donna; Penfold, Robert B; Simon, Gregory; Ahmedani, Brian K; Clarke, Gregory; Hunkeler, Enid M; Waitzfelder, Beth; Owen-Smith, Ashli; Raebel, Marsha A; Rossom, Rebecca; Coleman, Karen J; Copeland, Laurel A; Soumerai, StephenObjective: To investigate if the widely publicized warnings in 2003 from the US Food and Drug Administration about a possible increased risk of suicidality with antidepressant use in young people were associated with changes in antidepressant use, suicide attempts, and completed suicides among young people. Design: Quasi-experimental study assessing changes in outcomes after the warnings, controlling for pre-existing trends. Setting: Automated healthcare claims data (2000-10) derived from the virtual data warehouse of 11 health plans in the US Mental Health Research Network. Participants: Study cohorts included adolescents (around 1.1 million), young adults (around 1.4 million), and adults (around 5 million). Main outcome measures Rates of antidepressant dispensings, psychotropic drug poisonings (a validated proxy for suicide attempts), and completed suicides. Results: Trends in antidepressant use and poisonings changed abruptly after the warnings. In the second year after the warnings, relative changes in antidepressant use were −31.0% (95% confidence interval −33.0% to −29.0%) among adolescents, −24.3% (−25.4% to −23.2%) among young adults, and −14.5% (−16.0% to −12.9%) among adults. These reflected absolute reductions of 696, 1216, and 1621 dispensings per 100 000 people among adolescents, young adults, and adults, respectively. Simultaneously, there were significant, relative increases in psychotropic drug poisonings in adolescents (21.7%, 95% confidence interval 4.9% to 38.5%) and young adults (33.7%, 26.9% to 40.4%) but not among adults (5.2%, −6.5% to 16.9%). These reflected absolute increases of 2 and 4 poisonings per 100 000 people among adolescents and young adults, respectively (approximately 77 additional poisonings in our cohort of 2.5 million young people). Completed suicides did not change for any age group. Conclusions: Safety warnings about antidepressants and widespread media coverage decreased antidepressant use, and there were simultaneous increases in suicide attempts among young people. It is essential to monitor and reduce possible unintended consequences of FDA warnings and media reporting.Publication Cost-Related Medication Nonadherence and Spending on Basic Needs Following Implementation of Medicare Part D(American Medical Association (AMA), 2008) Madden, Jeanne; Graves, Amy; Zhang, Fang; Adams, Alyce S.; Briesacher, Becky A.; Ross-Degnan, Dennis; Gurwitz, Jerry H.; Pierre-Jacques, Marsha; Safran, Dana Gelb; Adler, Gerald; Soumerai, StephenContext Cost-related medication nonadherence (CRN) has been a persistent problem for individuals who are elderly and disabled in the United States. The impact of Medicare prescription drug coverage (Part D) on CRN is unknown. Objective To estimate changes in CRN and forgoing basic needs to pay for drugs following Part D implementation. Design, Setting, and Participants In a population-level study design, changes in study outcomes between 2005 and 2006 before and after Medicare Part D implementation were compared with historical changes between 2004 and 2005. The community-dwelling sample of the nationally representative Medicare Current Beneficiary Survey (unweighted unique n = 24 234; response rate, 72.3%) was used, and logistic regression analyses were controlled for demographic characteristics, health status, and historical trends. Main Outcome Measures Self-reports of CRN (skipping or reducing doses, not obtaining prescriptions) and spending less on basic needs to afford medicines. Results The unadjusted, weighted prevalence of CRN was 15.2% in 2004, 14.1% in 2005, and 11.5% after Part D implementation in 2006. The prevalence of spending less on basic needs was 10.6% in 2004, 11.1% in 2005, and 7.6% in 2006. Adjusted analyses comparing 2006 with 2005 and controlling for historical changes (2005 vs 2004) demonstrated significant decreases in the odds of CRN (ratio of odds ratios [ORs], 0.85; 95% confidence interval [CI], 0.74-0.98; P = .03) and spending less on basic needs (ratio of ORs, 0.59; 95% CI, 0.48-0.72; P < .001). No significant changes in CRN were observed among beneficiaries with fair to poor health (ratio of ORs, 1.00; 95% CI, 0.82-1.21; P = .97), despite high baseline CRN prevalence for this group (22.2% in 2005) and significant decreases among beneficiaries with good to excellent health (ratio of ORs, 0.77; 95% CI, 0.63-0.95; P = .02). However, significant reductions in spending less on basic needs were observed in both groups (fair to poor health: ratio of ORs, 0.60; 95% CI, 0.47-0.75; P < .001; and good to excellent health: ratio of ORs, 0.57; 95% CI, 0.44-0.75; P < .001). Conclusions In this survey population, there was evidence for a small but significant overall decrease in CRN and forgoing basic needs following Part D implementation. However, no net decrease in CRN after Part D was observed among the sickest beneficiaries, who continued to experience higher rates of CRN.Publication Cost-Related Medication Nonadherence After Implementation of Medicare Part D, 2006-2007(American Medical Association, 2009) Madden, Jeanne; Graves, Amy; Ross-Degnan, Dennis; Briesacher, Becky A.; Soumerai, StephenTo the Editor: High drug costs cause some elderly or disabled patients to take less medication than prescribed or forgo basic needs to pay for medicines. The 2006 Medicare Part D drug benefit was intended to increase economic access to medicines. Data from 2006 indicated modest nationwide decreases in cost-related medication nonadherence (CRN) and forgoing basic needs following Part D implementation, but no decline in high rates of CRN among the sickest beneficiaries. We analyzed more recent data to determine whether the reductions remained stable in 2007.Publication Effects of a Law against Early Postpartum Discharge on Newborn Follow-up, Adverse Events, and HMO Expenditures(New England Journal of Medicine (NEJM/MMS), 2002) Madden, Jeanne; Soumerai, Stephen; Lieu, Tracy; Mandl, Kenneth; Zhang, Fang; Ross-Degnan, DennisBACKGROUND Concern about harm to newborns from early postpartum discharges led to laws establishing minimum hospital stays in the mid-1990s. We evaluated the effects of an early-discharge protocol (a hospital stay of one postpartum night plus a home visit) in a health maintenance organization (HMO) and a subsequent state law guaranteeing a 48-hour hospital stay. METHODS Using interrupted–time-series analysis and data on 20,366 mother–infant pairs with normal vaginal deliveries, we measured changes in length of stay, newborn examinations on the third or fourth day of life, and office visits, emergency department visits, and hospital readmissions for newborns. We also examined expenditures for hospitalizations and home-based care. RESULTS The early-discharge program increased the rate of stays of less than two nights from 29.0 percent to 65.6 percent (P<0.001). The rate declined to 13.7 percent after the state mandate (P<0.001). The rate of newborn examinations on the third or fourth day of life increased from 24.5 percent to 64.4 percent with the program (P<0.001), then dropped to 53.0 percent after the mandate (P<0.001) — changes that primarily reflected changes in the rate of home visits. The rate of nonurgent visits to a health center increased from 33.4 percent to 44.7 percent (P<0.001) after the reduced-stay program was implemented. There were no significant changes in the rate of emergency department visits (quarterly mean, 1.1 percent) or rehospitalizations (quarterly mean, 1.5 percent). Results were similar for a vulnerable subgroup with lower incomes, younger maternal age, a lower level of education, or some combination of these characteristics. Average HMO expenditures on hospital and home-based services decreased by $90 per delivery with the early-discharge program and increased by $100 after the mandate. CONCLUSIONS Neither policy appears to have affected the health outcomes of newborns. After the mandate, newborns were less likely to be examined as recommended on day 3 or 4. Because of changes in hospital prices, the two policies had minimal effects on HMO expenditures for hospital and home-based services.Publication Changes in Drug Coverage Generosity and Untreated Serious Mental Illness(American Medical Association (AMA), 2015) Madden, Jeanne; Adams, Alyce S.; LeCates, Robert; Ross-Degnan, Dennis; Zhang, Fang; Huskamp, Haiden; Gilden, Daniel M.; Soumerai, StephenImportance More than 1 in 5 disabled people with dual Medicare-Medicaid enrollment have schizophrenia or a bipolar disorder (ie, a serious mental illness). The effect of their transition from Medicaid drug coverage, which varies in generosity across states, to the Medicare Part D drug benefit is unknown. Many thousands make this transition annually. Objectives To determine the effect of transitioning from Medicaid drug benefits to Medicare Part D on medication use by patients with a serious mental illness and to determine the influence of Medicaid drug caps. Design, Setting, and Participants In time-series analysis of continuously enrolled patient cohorts (2004-2007), we estimated changes in medication use before and after transitioning to Part D, comparing states that capped monthly prescription fills with states with no prescription limits. We used Medicaid and Medicare claims from a 5% national sample of community-dwelling, nonelderly disabled dual enrollees with schizophrenia (n = 5554) or bipolar disorder (n = 3675). Main Outcomes and Measures Psychotropic treatments included antipsychotics for schizophrenia and antipsychotics, anticonvulsants, and lithium for bipolar disorder. We measured monthly rates of untreated illness, intensity of treatment, and overall prescription medication use. Results Prior to Part D, the prevalence of untreated illness among patients with a bipolar disorder was 30.0% in strict-cap states and 23.8% in no-cap states. In strict-cap states, the proportion of untreated patients decreased by 17.2% (relatively) 1 year after Part D, whereas there was no change in the proportion of untreated patients in no-cap states. For patients with schizophrenia, the untreated rate (20.6%) did not change in strict-cap states, yet it increased by 23.3% (from 11.6%) in no-cap states. Overall medication use increased substantially after Part D in strict-cap states: prescription fills were 35.5% higher among patients with a bipolar disorder and 17.7% higher than predicted among schizophrenic patients; overall use in no-cap states was unchanged in both cohorts. Conclusions and Relevance The effects of transitioning from Medicaid to Medicare Part D on essential treatment of serious mental illness vary by state. Transition to Part D in states with strict drug benefit limits may reduce rates of untreated illness among patients with bipolar disorders, who have high levels of overall medication use. Access to antipsychotic treatment may decrease after Part D for patients with a serious mental illness living in states with relatively generous uncapped Medicaid coverage.Publication High-Deductible Health Plans Paired With Health Savings Accounts Increased Medication Cost Burden Among Individuals With Bipolar Disorder(Physicians Postgraduate Press, Inc, 2022-03-09) Lu, Christine Y.; Zhang, Fang; Wallace, Jamie; LeCates, Robert; Busch, Alisa; Madden, Jeanne; Callahan, Matthew; Foxworth, Phyllis; Soumerai, Stephen; Ross-Degnan, Dennis; Wharam, JamesObjective: High-deductible health plans (HDHPs) paired with health savings accounts (HSAs) require substantial out-of-pocket spending for most services, including medications. We examined effects of HSA-eligible HDHPs on medication out-of-pocket spending and use among those with bipolar disorder. Methods: This was a quasi-experimental study using claims data (01/2003-12/2014). We studied a national sample of 348 members with bipolar disorder, aged 12 to 64 years, who were continuously enrolled for 1-year in a low-deductible plan (≤USD500) then 1-year in an HSA-eligible HDHP (≥USD1000) after an employer-mandated switch. HSA-HDHP members were matched to 4,087 contemporaneous controls who remained in low-deductible plans. Outcome measures included out-of-pocket spending and use of bipolar disorder medications, non-bipolar psychotropics, and all other medications. Results: Pre-to-post out-of-pocket spending per person for bipolar disorder medications increased 150.0% among HSA-HDHP members, relative to controls (95%CI: 109.9%, 189.5%). Specifically, out-of-pocket spending increased for antipsychotics (220.9% [95%CI: 150.0%, 291.8%]) and anticonvulsants (109.6% [95%CI: 67.3%, 152.0%]); the increase for lithium did not reach statistical significance (25% [95%CI: -5.5%, 55.4%]). We did not detect statistically significant changes in use of bipolar disorder medications, non-bipolar psychotropics, or all other medications. Conclusions: We did not detect changes in medication use among HSA-HDHP members. However, HSA-HDHP members experienced substantial and concerning increases in out-of-pocket burdens for medications essential for their functioning and well-being, which could be a financial strain for some people.