       Document 0578
 DOCN  M9620578
 TI    The diffusion of innovation in AIDS treatment: zidovudine use in two New
       Jersey cohorts.
 DT    9602
 AU    Crystal S; Sambamoorthi U; Merzel C; Institute for Health, Health Care
       Policy, and Aging Research,; Rutgers University, New Brunswick, NJ
       08903, USA.
 SO    Health Serv Res. 1995 Oct;30(4):593-614. Unique Identifier : AIDSLINE
       MED/96006240
 AB    OBJECTIVE. This study investigates patterns of utilization of zidovudine
       (ZDV) by gender, race, risk group, and other respondent characteristics
       following approval of this treatment. STUDY POPULATION. Longitudinal
       observational data were used on a demographically diverse population
       participating in New Jersey's Medicaid waiver program for persons with
       symptomatic HIV disease. DATA EXTRACTION METHODS. Claims data were
       merged with administrative data on demographic characteristics, risk
       group, and functional status. Periods of ZDV utilization were determined
       by analysis of pharmacy claims. DESIGN. The proportion of respondents
       ever using ZDV (treatment incidence) and the proportion of time on ZDV
       among users (treatment persistence) were analyzed for a cohort enrolling
       in 1987 and 1988, and for a cohort enrolling in 1989 and 1990, with
       follow-up of utilization through August 1992. For each cohort, bivariate
       analyses were used to compare incidence and persistence by patient
       subgroup; logistic regression was used to investigate the predictors of
       incidence in a multivariate model; and OLS regression was used to
       analyze proportion of time on ZDV among those with any ZDV use.
       PRINCIPAL FINDINGS. For the 1987-1988 cohort, substantial race, gender,
       and risk group differences in utilization were observed, even though all
       participants in this Medicaid population had financial coverage for ZDV
       treatment. Treatment incidence was significantly lower for blacks than
       for others in bivariate comparison (45 percent versus 63 percent had any
       use of ZDV) and in a logistic regression controlling for a variety of
       demographic and health status indicators (relative risk .46, CI .31 a
       variety of demographic and health status indicators (relative risk .46,
       CI .31 to .69). Treatment persistence differences were also substantial
       in the 1987-1988 cohort: among ZDV users, women, blacks, and injection
       drug users (IDUs) had significantly less persistence in use, and the
       gender and risk group differences were significantly in a multivariate
       model. In the 1989-1990 cohort, however, both incidence and persistence
       of treatment converged: no significant differences were observed across
       demographic groups. CONCLUSIONS. Less-advantaged subgroups lagged in
       access to this new therapy, suggesting the presence of nonfinancial
       barriers to care. However, these initial differences subsequently
       converged. RELEVANCE/IMPACT. Socioeconomic differences have been
       observed in access to newly introduced treatments for a variety of
       diseases, reflecting nonfinancial as well as financial barriers to care.
       Such differences may or may not disappear as use of therapies becomes
       institutionalized. Monitoring patterns of treatment initiation as well
       as persistence of treatment over time, using merged data from claims and
       administrative files, can provide important information on the diffusion
       of treatments and the extent to which initial disparities are or are not
       reduced over time.
 DE    Acquired Immunodeficiency Syndrome/*DRUG THERAPY/ETHNOLOGY/
       EPIDEMIOLOGY  Adult  Antiviral Agents/*THERAPEUTIC USE  Cohort Studies
       Comparative Study  *Diffusion of Innovation  Drug Utilization/STATISTICS
       & NUMER DATA  Female  Health Services Accessibility  Human  Longitudinal
       Studies  Male  Middle Age  Multivariate Analysis  New
       Jersey/EPIDEMIOLOGY  Registries  Regression Analysis  Risk Factors
       Socioeconomic Factors  Support, U.S. Gov't, P.H.S.
       Zidovudine/*THERAPEUTIC USE  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

