Assessing Potentially Inappropriate Prescribing in the Elderly Veterans Affairs Population Using the HEDIS 2006 Quality Measure

Pugh, Mary Jo; Hanlon, Joseph T.; Zeber, John E.; Bierman, Arlene S.; Cornell, John E.; Berlowitz, Dan R.

doi:10.18553/jmcp.2006.12.7.537

Cited by 89 publications

(91 citation statements)

References 57 publications

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“…9,10,16 In the September 2006 issue of JMCP, Pugh et al assessed potentially inappropriate prescribing in an elderly Department of Veterans Affairs (VA) population using the HEDIS 2006 quality measure. 18 In the VA population in Pugh et al's study, 19.6% of patients were exposed to a HEDIS 2006 drug, similar to the exposure rate in other studies where 20%-25% of patients received drugs identified as inappropriate by the 1997 Beers criteria. 18 Unfortunately, Pugh et al's analysis, like most of the studies in the literature, did not link exposure to actual adverse patient outcomes.…”

supporting

confidence: 65%

“…18 In the VA population in Pugh et al's study, 19.6% of patients were exposed to a HEDIS 2006 drug, similar to the exposure rate in other studies where 20%-25% of patients received drugs identified as inappropriate by the 1997 Beers criteria. 18 Unfortunately, Pugh et al's analysis, like most of the studies in the literature, did not link exposure to actual adverse patient outcomes.…”

supporting

confidence: 65%

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Adverse Drug Events in the Elderly: An Ongoing Problem

Gray

Gardner²

2009

JMCP

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formal continuing medical education (CME) programs, pocket cards listing high-risk medications, messaging in the electronic medical record suggesting therapeutic alternatives to high-risk medications, focused therapeutic interchange initiatives, and dissemination of "frequently asked questions" documents. These tools are designed to explain, teach, and reinforce the message that many drugs adversely affect older patients by leading to falls, fractures, and functional and cognitive decline, and sometimes to unnecessary and costly hospitalizations and nursing home placements.For example, recent attention at KP has focused on suggesting safer alternatives to skeletal muscle relaxants and long-acting benzodiazepines. Educational presentations to practitioners include suggestions for safer medications, as well as nonpharmacologic interventions, in treating musculoskeletal pain. Another initiative provided education about alternatives to antihistamines such as diphenhydramine, hydroxyzine, and promethazine. Specific recommendations were made regarding alternatives (based on the indication, such as sleep or cough) including nonpharmacologic treatment strategies as appropriate.KP regions have programs devoted to caring for patients who are older, frail, or have multiple chronic conditions. Many such programs include the opportunity for a clinical pharmacy specialist to participate in evaluating and reconciling those patients' medications, especially during transitions in care settings such as from hospital to home.In KP of Georgia, one such program includes an interdisciplinary team consisting of a geriatrician, nurse care manager, nurse, and clinical pharmacy specialist. The team evaluates and treats older patients identified as high risk through predictive modeling based upon chronic medical conditions and other factors. Much of the work is conducted telephonically, using the electronic health record to document and communicate recommendations to the patients and their treating physicians. In many cases, the clinical pharmacist works closely with the patient's primary care physician (PCP) to implement changes under the PCP's supervision. The team thoroughly evaluates overall functional and health status, including review of all prescribed and over-the-counter medications and supplements, and makes recommendations for changes to optimize regimens and patient safety. Annual program evaluation includes measurement of number of program enrollees identified as having been prescribed medications on the Healthcare Effectiveness Data and Information Set (HEDIS) high risk list, and whether the team recommended/made changes to the regimen. New tools are being developed to enhance the team's effectiveness in addressing this issue. B y the year 2030, nearly 1 in 5 U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double in number from 38.7 million in 2008 to more than 88.5 million in 2050.1,2 Likewise, the population aged 85 years or older is expected to increase almost 4-fold, from...

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supporting

confidence: 65%

supporting

confidence: 65%

Adverse Drug Events in the Elderly: An Ongoing Problem

Gray

Gardner²

2009

JMCP

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“…A more detailed description of this process 16 and comparison of the HEDIS measure with other criteria can be found elsewhere. 17 …”

Section: Data Sourcesmentioning

confidence: 99%

Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans

Qato

Trivedi

2012

J GEN INTERN MED

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In fully adjusted models, females had a 10.6 (95 % CI: 10.0-11.2) higher percentage point rate of receipt than males, and residence in any of the Southern United States divisions was associated with a greater than 10 percentage point higher rate, as compared with the reference New England division. Higher rates were also observed among enrollees with low personal income (6.5 percentage points, 95 % CI: 5.5-7.5), relative to those without low income and those residing in areas in the lowest quintile of socioeconomic status (2.7 points, 95 % CI: 1.9-3.4) relative to persons residing in the highest quintile. Enrollees ≥ 85 years old, black enrollees, and other minority groups were less likely to receive these medications. Over 38 % of MA enrollees residing in the hospital referral region of Albany, Georgia received at least one HRM, a rate four times higher than the referral region with the lowest rate (Mason City, Iowa). CONCLUSIONS: Use of HRMs among MA enrollees varies widely by geographic region. Persons living in the Southern region of the U.S., whites, women, and persons of low personal income and socioeconomic status are more likely to receive HRMs.

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“…26 A separate study of nearly 1.1 million VA beneficiaries aged 65 years or older for the same 12-month period from October 1, 1999, through September 30, 2000, found a 19.6% overall prevalence of PIM use using the NCQA-HEDIS 2006 list of DAEs to define PIMs. 19 In both VA samples, propoxyphene was the highest use PIM (Table 2). In the study of approximately 1.1 million VA beneficiaries (98% male), 4.5% received propoxyphene at least once in the 12-month period (5.7% of females and 4.5% of males).…”

Section: Public Health Implications Of Evidence About Analgesic Safetmentioning

confidence: 96%

“…27 The Beers criteria expert panel in 1997 classified the severity of adverse effects associated with propoxyphene as "not high," 28 and the Beers 2003 criteria classified propoxyphene severity of adverse effects as "low." 29 The prevalence of propoxyphene use in older adults has been persistent despite its inclusion in the HEDIS list of DAEs from the NCQA since 2006 18,19,21,22 and assessment of the DAE utilization rate as a quality measure for health plans including all Medicare managed care contractors. 30 The analyses of PIM prevalence reported by Zhan et al as part of the AHRQ-funded development of a 3-category, 33-PIM list found that propoxyphene utilization, measured as the percentage of community-dwelling elderly receiving propoxyphene, rose from 4.8% in the 1987 National Medical Care Expenditure Survey, to 5.6% in the 1992 Medicare Current Beneficiary Survey, and 6.2% in the 1996 Medical Expenditure of population-level harm, but instead provide guidance for evaluation of the appropriateness of use in individual cases and opportunities for continuous evaluation of the evidence that supports the association between PIM exposure and actual patient harm.…”

Section: Resilient Use Of Propoxyphenementioning

confidence: 99%