T hrough an analysis of 118,456 health care records of veterans receiving in-patient care for myocardial infarction (MI) at Veteran's Health Administration (VHA) hospitals versus non-VHA hospitals, Weeda et al 1 found that veterans treated at the VHA hospitals were much less likely to receive duplicate prescriptions, have omissions in any medication class of recommended secondary prevention medications; or to experience delays of 3 days or more in filling prescriptions. Since patients with MI are usually transported to the closest hospital, the sample of veterans treated in non-VHA hospitals was considerably larger than those taken directly to a VHA hospital (102,209 vs 16,247 patients). This study examined the accuracy of prescribing and filling of medications in 4 classes of agents with demonstrated evidence of treatment effectiveness: beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, and P2Y12 inhibitors, such as clopidogrel, prasugrel, or ticagrelor. The authors note that the likelihood of a veteran experiencing an MI is twice as high as nonveterans 2 and an increasing trend toward veterans receiving care outside of the VHA system 3 demonstrates the importance of examining the care process and outcomes across both systems for this vulnerable, high-risk population. In their review of the literature, they found a paucity of information on the medication prescription and follow-up processes in conditions as critical as an MI.Qualified veterans who enroll in the VHA care system receive comprehensive care that includes illness and injury treatment, and services to sustain health, improve function, and enhance quality of life. Coverage meets the "minimum essential coverage" required through the Affordable Care Act and can be used with other services, such as Medicare, Medicaid, and private insurance. 4 The range of services provided by the VHA system is determined through a priority system where factors, such as disabilities or medical conditions, directly related to service, meritorious recognition for service, and financial need enhance the degree of coverage provided. 5 These veterans are older and more likely to have financial needs than veterans who do not use VHA services. In addition to being more likely to experience homelessness, they are more medically complex with higher rates of post-traumatic stress disorder, diabetes, gastrointestinal reflux disease, hypertension, ischemic heart disease, hearing loss, cancer, and chronic obstructive pulmonary disease than the civilian population. They are also more likely to be members of ethnic or racial minority groups, have lower income, experience anxiety and mental distress, and report their health status as fair or poor. 6,7 Compared with the general population, VHA patients also have higher medical resource use. However, when the complexity of health and social differences are considered, the VHA patient's resource use is comparable and appropriate. Interestingly, veterans who do not use the VHA resemble the genera...
