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. (16th October 2018)

• Record Type: Journal Article
• Authors: Thorpe, Carolyn T.; Gellad, Walid F.; Mor, Maria K.; Cashy, John P.; Pleis, John R.; Van Houtven, Courtney H.; Schleiden, Loren J.; Hanlon, Joseph T.; Niznik, Joshua D.; Carico, Ronald L.; Good, Chester B.; Thorpe, Joshua M.
• Other Names: Hynes Denise M. guestEditor.; Maciejewski Matthew L. guestEditor.
• Is Part Of: Health services research. Volume 53(2018)Supplement 3
• Page Start: 5375
• Page End: 5401
• Publication Date: 2018-10-16
• Subjects: Dementia -- hypertension -- medication use -- Veterans -- Medicare Part D; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.13055
• Languages: English
• ISSNs: 0017-9124

Abstract

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.