Predicting patient activation and its effect on securing Medicare Part D information Public Deposited

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Last Modified
  • March 22, 2019
Creator
  • Butler, Melissa G.
    • Affiliation: Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy
Abstract
  • More and more health care decisions are being placed in the hands of patients. Patients might make the best decisions if they are motivated, knowledgeable, and have the necessary skills. Patients who are highly activated have these characteristics. In 2006, Medicare beneficiaries were given the new task of making decisions about their prescription drug coverage. This dissertation focused on the relationship between patient activation (PA) and information-seeking behavior about the Medicare Prescription Drug Program (Medicare Part D) because the examination of a relationship between PA and preparing for Medicare prescription drug coverage decisions has been limited. In addition, I examined whether modifiable factors, such as social environmental variables, predicted PA to help identify places for intervention. Lastly, I assessed whether the relationships I studied differed across racial and ethnic subgroups. The 2004 and 2005, Medicare Current Beneficiary Surveys were used to study these relationships in Medicare beneficiaries. My conceptual framework was based on the Wilson Model for Information Behavior, the Chronic Care Model, and the Conceptual Model of How Social Networks Impact Health. I found that social environmental variables, such as patient perceptions of physicians and social support, improved PA, but community variables had no effect on PA (n = 9,082). Beneficiaries with higher levels of PA were more likely to seek Medicare Part D information and, therefore, were more prepared to make Medicare Part D decisions. Lastly, I found that there were differences in these relationships across white, black, and Hispanic beneficiaries; thus, interventions should be culture specific. Although this dissertation focused on beneficiaries, system-wide changes might improve Medicare Part D decision making irrespective of a beneficiary's level of activation. These include increasing awareness of the benefits of reviewing information about choices, disseminating information through the information channel that beneficiaries prefer to learn about Medicare, and simplifying information so that it is easier for beneficiaries to make choices.
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  • In Copyright
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  • ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Pharmaceutical Sciences, Eshelman School of Pharmacy.
Advisor
  • Murray, Michael
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