Center for Health Equity Research and Promotion
Risky dual-use prescribing for Veterans
A recent report by CHERP Investigators and colleagues regarding the safety risks of patients with dementia using both Medicare and VA for their prescriptions was featured in a number of national media outlets, including these:
Dementia Drug Safety
In Dementia Care From Multiple Health Systems Poses Drug Safety Risks
In addition, the Annals of Internal Medicine published an editorial to accompany the report: The Veterans Affairs Pharmacy System: Perfectly Designed to Achieve the Outcomes It Gets
The report is titled “Dual Health Care System Use and High-Risk Prescribing in Dementia Patients. A National Cohort Study.” The authors are J.M. Thorpe, C.T. Thorpe, W.F. Gellad, C.B. Good, J.T. Hanlon, M.K. Mor, J.R. Pleis, L.J. Schleiden, and C.H. Van Houtven.
Principal Investigator Joshua M. Thorpe, PhD, MPH, provided the following Q&A on the report.
What is the problem and what is known about it so far?
Recently, the federal government enacted policies that increase veterans’ access to health care provided by clinicians who are not affiliated with the U.S. Department of Veterans Affairs (VA).
Why did the researchers do this particular study?
Because of the lack of coordination between VA and non-VA health systems, veterans who see doctors in both settings may be prescribed drugs that are not safe for them, especially if they have high-risk conditions, such as dementia.
Who was studied?
75,829 veterans who had a diagnosis of dementia and were eligible for Medicare benefits between 2009 and 2010. They had to have at least 1 outpatient visit to the VA during 2010; patients who were seen only in the emergency department or had hospitalizations only were not included in the study.
How was the study done?
The researchers combined information on the patients’ diagnoses and medication use from different electronic files maintained by Medicare and the VA. They then compared the risk for receiving prescriptions for possibly unsafe medications (PUMs) for 2 groups of dementia patients: those who received only VA prescriptions and those who received VA and Medicare Part D prescriptions (this group was defined as “dual users”).
What did the researchers find?
The average age of the patients was 82 years, and almost all were men. Approximately 80% received only VA prescriptions, and 20% received both VA and Medicare Part D prescriptions. These dual users had more than twice the risk for receiving prescriptions for PUMs, including drugs that are potentially harmful in elderly patients. Dual users were exposed to PUMs for a longer time (an extra 1.5 months) than patients who received only VA prescriptions.
What were the limitations of the study?
The researchers did not study other unsafe medication situations, such as interactions between drugs or use of unsafe over-the-counter medications.
What are the implications of the study?
The risks for being prescribed PUMs are higher for dual users than those who use only the VA for their health care. The results highlight the need for increased coordination between VA and Medicare to help reduce unsafe prescribing for dementia patients seeking medications across healthcare systems.
The contents in this article and on this website do not necessarily represent the views of the Department of Veterans Affairs or the US Government.