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Dual Health Care System Use and High-Risk Prescribing in Patients With Dementia: A National Cohort Study.

Publication ,  Journal Article
Thorpe, JM; Thorpe, CT; Gellad, WF; Good, CB; Hanlon, JT; Mor, MK; Pleis, JR; Schleiden, LJ; Van Houtven, CH
Published in: Ann Intern Med
February 7, 2017

BACKGROUND: Recent federal policy changes attempt to expand veterans' access to providers outside the Department of Veterans Affairs (VA). Receipt of prescription medications across unconnected systems of care may increase the risk for unsafe prescribing, particularly in persons with dementia. OBJECTIVE: To investigate the association between dual health care system use and potentially unsafe medication (PUM) prescribing. DESIGN: Retrospective cohort study. SETTING: National VA outpatient care facilities in 2010. PARTICIPANTS: 75 829 veterans with dementia who were continuously enrolled in Medicare from 2007 to 2010; 80% were VA-only users, and 20% were VA-Medicare Part D (dual) users. MEASUREMENTS: Augmented inverse propensity weighting was used to estimate the effect of dual-system versus VA-only prescribing on 4 indicators of PUM prescribing in 2010: any exposure to Healthcare Effectiveness Data and Information Set (HEDIS) high-risk medication in older adults (PUM-HEDIS), any daily exposure to prescriptions with a cumulative Anticholinergic Cognitive Burden (ACB) score of 3 or higher (PUM-ACB), any antipsychotic prescription (PUM-antipsychotic), and any PUM exposure (any-PUM). The annual number of days of each PUM exposure was also examined. RESULTS: Compared with VA-only users, dual users had more than double the odds of exposure to any-PUM (odds ratio [OR], 2.2 [95% CI, 2.2 to 2.3]), PUM-HEDIS (OR, 2.4 [CI, 2.2 to 2.8]), and PUM-ACB (OR, 2.1 [CI, 2.0 to 2.2]). The odds of PUM-antipsychotic exposure were also greater in dual users (OR, 1.5 [CI, 1.4 to 1.6]). Dual users had an adjusted average of 44.1 additional days of any-PUM exposure (CI, 37.2 to 45.0 days). LIMITATION: Observational study design of veteran outpatients only. CONCLUSION: Among veterans with dementia, rates of PUM prescribing are significantly higher among dual-system users than with VA-only users. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs.

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Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

February 7, 2017

Volume

166

Issue

3

Start / End Page

157 / 163

Location

United States

Related Subject Headings

  • United States Department of Veterans Affairs
  • United States
  • Risk Factors
  • Retrospective Studies
  • Medicare Part D
  • Inappropriate Prescribing
  • Humans
  • General & Internal Medicine
  • Dementia
  • Antipsychotic Agents
 

Citation

APA
Chicago
ICMJE
MLA
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Thorpe, J. M., Thorpe, C. T., Gellad, W. F., Good, C. B., Hanlon, J. T., Mor, M. K., … Van Houtven, C. H. (2017). Dual Health Care System Use and High-Risk Prescribing in Patients With Dementia: A National Cohort Study. Ann Intern Med, 166(3), 157–163. https://doi.org/10.7326/M16-0551
Thorpe, Joshua M., Carolyn T. Thorpe, Walid F. Gellad, Chester B. Good, Joseph T. Hanlon, Maria K. Mor, John R. Pleis, Loren J. Schleiden, and Courtney Harold Van Houtven. “Dual Health Care System Use and High-Risk Prescribing in Patients With Dementia: A National Cohort Study.Ann Intern Med 166, no. 3 (February 7, 2017): 157–63. https://doi.org/10.7326/M16-0551.
Thorpe JM, Thorpe CT, Gellad WF, Good CB, Hanlon JT, Mor MK, et al. Dual Health Care System Use and High-Risk Prescribing in Patients With Dementia: A National Cohort Study. Ann Intern Med. 2017 Feb 7;166(3):157–63.
Thorpe, Joshua M., et al. “Dual Health Care System Use and High-Risk Prescribing in Patients With Dementia: A National Cohort Study.Ann Intern Med, vol. 166, no. 3, Feb. 2017, pp. 157–63. Pubmed, doi:10.7326/M16-0551.
Thorpe JM, Thorpe CT, Gellad WF, Good CB, Hanlon JT, Mor MK, Pleis JR, Schleiden LJ, Van Houtven CH. Dual Health Care System Use and High-Risk Prescribing in Patients With Dementia: A National Cohort Study. Ann Intern Med. 2017 Feb 7;166(3):157–163.

Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

February 7, 2017

Volume

166

Issue

3

Start / End Page

157 / 163

Location

United States

Related Subject Headings

  • United States Department of Veterans Affairs
  • United States
  • Risk Factors
  • Retrospective Studies
  • Medicare Part D
  • Inappropriate Prescribing
  • Humans
  • General & Internal Medicine
  • Dementia
  • Antipsychotic Agents