Effect of Dual Use of Veterans Affairs and Medicare Part D Drug Benefits on Antihypertensive Medication Supply in a National Cohort of Veterans with Dementia

Abstract

Objective To evaluate the effect of dual use of VA/Medicare Part D drug benefits on antihypertensive medication supply in older Veterans with dementia. Data Sources/Study Setting National, linked 2007–2010 Veterans Affairs (VA) and Medicare utilization and prescription records for 50,763 dementia patients with hypertension. Study Design We used inverse probability of treatment (IPT)‐weighted multinomial logistic regression to examine the association of dual prescription use with undersupply and oversupply of antihypertensives. Data Collection/Extraction Methods Veterans Affairs and Part D prescription records were used to classify patients as VA‐only, Part D‐only, or dual VA/Part D users of antihypertensives and summarize their antihypertensive medication supply in 2010: (1) appropriate supply of all prescribed antihypertensive classes, (2) undersupply of ≥1 class with no oversupply of another class, (3) oversupply of ≥1 class with no undersupply, or (4) both undersupply and oversupply. Principal Findings Dual prescription users were more likely than VA‐only users to have undersupply only (aOR = 1.28; 95 percent CI = 1.18–1.39), oversupply only (aOR = 2.38; 95 percent CI = 2.15–2.64), and concurrent under‐ and oversupply (aOR = 2.89; 95 percent CI = 2.53–3.29), versus appropriate supply of all classes. Conclusions Obtaining antihypertensives through both VA and Part D was associated with increased antihypertensive under‐ and oversupply. Efforts to understand how best to coordinate dual‐system prescription use are critically needed.

Racial/Ethnic Differences in the Medical Treatment of Opioid Use Disorders Within the VA Healthcare System Following Non-Fatal Opioid Overdose

“…The clinical variables consisted of a combined measure of comorbidity captured by the Gagne Index (a clinical risk adjustment score based on 20 conditions derived from the Charlson and Elixhauser indices that predicts 1-year all-cause mortality) 15 in the year prior to overdose, and a measure of VA disability status (based on VA priority enrollment group status and defined as high disability, low/moderate disability, low income, and no serviceconnected disability). 16 Finally, we used the patients' Federal Information Processing Standards (FIPS) code of residence to assess driving distance to the nearest VA primary care clinic and geographic census region (Northeast, Midwest, South, West, outside the 50 states and DC). The analysis also included patient-level rurality (large metro, small metro, micropolitan, and non-core rural).…”

Dual Receipt of Prescription Opioids From the Department of Veterans Affairs and Medicare Part D and Prescription Opioid Overdose Death Among Veterans

“…Furthermore, use of multiple health systems could undermine the effectiveness of VA’s internal efforts to discourage opioid overuse and reduce opioid-related harms (14, 15). Evidence from prior studies indicates that receipt of care from unconnected health systems is associated with excess use and costs (9, 16–18) and increased risk for potentially unsafe prescribing of opioids and other medications (11, 12, 19, 20). Among veterans dually enrolled in VA and Part D, receiving opioids from both systems (that is, dual use) is associated with significantly increased risk for highdose opioid exposure (12) and overlapping opioid and benzodiazepine prescriptions (20), both of which are strongly associated with increased risk for overdose death (21–23).…”

HSR Commentary: Linking VA and Non‐VA Data to Address Important US Veteran Health Services Research Issues

“…The papers in this special issue used a range of non-VA datasets, several presented for the first time in a research application. Medicare data were the most commonly linked data (used in Wang et al 2018;Thorpe et al 2018;Vaughan Sarrazin et al 2018;Trivedi et al 2018;Reddy et al 2018;Nelson et al 2018a, b;Vanneman et al 2018;Liu et al 2018;Chui et al 2018;Hebert et al 2018;Lei et al 2018), because these data have been available to VA researchers within the VA under an agreement with Centers for Medicare and Medicaid Services via the VIReC for more than fifteen years and have well-established documentation and file structures (Hynes et al 2007). Other non-VA datasets used by authors in this special issue included US Renal Data System (USRDS) (Wang et al 2018), state data from California birth records (Shaw et al 2018), and Oregon prescription drug monitoring program (PDMP) data (Carlson et al 2018).…”

“…Other non-VA datasets used by authors in this special issue included US Renal Data System (USRDS) (Wang et al 2018), state data from California birth records (Shaw et al 2018), and Oregon prescription drug monitoring program (PDMP) data (Carlson et al 2018). These papers leveraged the linked data they created to address a range of topics, including VA and non-VA health care use and costs (Wang et al 2018;Vaughan Sarrazin et al 2018;Hebert et al 2018;Vanneman et al 2018;Liu et al 2018;Lei et al 2018), medication use (Thorpe et al 2018;Carlson et al 2018;and Chiu et al 2018), and the impact of homelessness on health care use and costs (Nelson et al 2018, andTrivedi et al 2018). One study focused on health care use in VA and VA community care (Rosen et al 2018).…”

“…One study focused on health care use in VA and VA community care (Rosen et al 2018). Clinical conditions addressed included mental health , dementia (Thorpe et al 2018;Lei et al 2018), end-stage kidney disease (Wang et al 2018), pain management (Carlson et al 2018;Chiu et al 2018), high-risk pregnancy (Shaw et al 2018), and infectious disease (Nelson et al 2018). Two studies linked Medicare data to examine the impact of the VA's patient aligned care team intervention Reddy et al 2018).…”