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Trends in Use of High‐Risk Medications for Older Veterans: 2004 to 2006
Author(s) -
Pugh Mary Jo V.,
Hanlon Joseph T.,
Wang ChenPin,
Semla Todd,
Burk Muriel,
Amuan Megan E.,
Lowery Ashlei,
Good Chester B.,
Berlowitz Dan R.
Publication year - 2011
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2011.03559.x
Subject(s) - medicine , veterans affairs , polypharmacy , ambulatory , retrospective cohort study , emergency medicine , comorbidity
OBJECTIVES: To examine the change in use of high‐risk medications for the elderly (HRME), as defined by the National Committee on Quality Assurance's Healthcare Effectiveness Data and Information Set (HEDIS) quality measure (HEDIS HRME), by older outpatient veterans over a 3‐year period and to identify risk factors for HEDIS HRME exposure overall and for the most commonly used drug classes.DESIGN: Longitudinal retrospective database analysis.SETTING: Outpatient clinics within the Department of Veterans Affairs (VA).PARTICIPANTS: Veterans aged 65 by October 1, 2003, and who received VA care at least once each year until September 30, 2006.MEASUREMENTS: Rates of use of HEDIS HRME overall and according to specific drug classes each year from fiscal year 2004 (FY04) to FY06.RESULTS: In a cohort of 1,567,467, high‐risk medication exposure fell from 13.1% to 12.3% between FY04 and FY06 ( P <.001). High‐risk antihistamines (e.g., diphenhydramine), opioid analgesics (e.g., propoxyphene), skeletal muscle relaxants (e.g., cyclobenzaprine), psychotropics (e.g., long half‐life benzodiazepines), endocrine (e.g., estrogen), and cardiac medications (e.g., short‐acting nifedipine) had modest but statistically significant ( P <.001) reductions (range −3.8% to −16.0%); nitrofurantoin demonstrated a statistically significant increase (+36.5%; P <.001). Overall HEDIS HRME exposure was more likely for men, Hispanics, those receiving more medications, those with psychiatric comorbidity, and those without prior geriatric care. Exposure was lower for individuals exempt from copayment. Similar associations were seen between ethnicity, polypharmacy, psychiatric comorbidity, access‐to‐care factors, and use of individual HEDIS HRME classes.CONCLUSION: HEDIS HRME drug exposure decreased slightly in an integrated healthcare system. Risk factors for exposure were not consistent across drug groups. Future studies should examine whether interventions to further reduce HEDIS HRME use improve health outcomes.