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
Corresponding Author
Carolyn T. Thorpe Ph.D., M.P.H.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
Address correspondence to Carolyn T. Thorpe, Ph.D., M.P.H., Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA 15240; and also with the UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC; e-mail: [email protected].Search for more papers by this authorWalid F. Gellad M.D., M.P.H.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Search for more papers by this authorMaria K. Mor Ph.D.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Search for more papers by this authorJohn P. Cashy Ph.D.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Search for more papers by this authorJohn R. Pleis Ph.D.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Search for more papers by this authorCourtney H. Van Houtven Ph.D.
Durham Veterans Affairs Health Care System, VA Medical Center (152), Durham, NC
Duke University School of Medicine, VA Medical Center (152), Durham, NC
Search for more papers by this authorLoren J. Schleiden M.S.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
University of Pittsburgh School of Pharmacy, Pittsburgh, PA
Search for more papers by this authorJoseph T. Hanlon Pharm.D., M.S.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
Search for more papers by this authorJoshua D. Niznik Pharm.D.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
University of Pittsburgh School of Pharmacy, Pittsburgh, PA
Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
Search for more papers by this authorRonald L. Carico Jr. Pharm.D., M.P.H.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
University of Pittsburgh School of Pharmacy, Pittsburgh, PA
Search for more papers by this authorChester B. Good M.D., M.P.H.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Center for High Value Pharmaceutical Purchasing, UPMC Health Plan, Pittsburgh, PA
Search for more papers by this authorJoshua M. Thorpe Ph.D., M.P.H.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
Search for more papers by this authorCorresponding Author
Carolyn T. Thorpe Ph.D., M.P.H.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
Address correspondence to Carolyn T. Thorpe, Ph.D., M.P.H., Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA 15240; and also with the UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC; e-mail: [email protected].Search for more papers by this authorWalid F. Gellad M.D., M.P.H.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Search for more papers by this authorMaria K. Mor Ph.D.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Search for more papers by this authorJohn P. Cashy Ph.D.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Search for more papers by this authorJohn R. Pleis Ph.D.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Search for more papers by this authorCourtney H. Van Houtven Ph.D.
Durham Veterans Affairs Health Care System, VA Medical Center (152), Durham, NC
Duke University School of Medicine, VA Medical Center (152), Durham, NC
Search for more papers by this authorLoren J. Schleiden M.S.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
University of Pittsburgh School of Pharmacy, Pittsburgh, PA
Search for more papers by this authorJoseph T. Hanlon Pharm.D., M.S.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
Search for more papers by this authorJoshua D. Niznik Pharm.D.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
University of Pittsburgh School of Pharmacy, Pittsburgh, PA
Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
Search for more papers by this authorRonald L. Carico Jr. Pharm.D., M.P.H.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
University of Pittsburgh School of Pharmacy, Pittsburgh, PA
Search for more papers by this authorChester B. Good M.D., M.P.H.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Center for High Value Pharmaceutical Purchasing, UPMC Health Plan, Pittsburgh, PA
Search for more papers by this authorJoshua M. Thorpe Ph.D., M.P.H.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
Search for more papers by this authorAbstract
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.
Supporting Information
| Filename | Description |
|---|---|
| hesr13055-sup-0001-AppendixSA1.pdfPDF document, 1.2 MB | Appendix SA1: Author Matrix. |
| hesr13055-sup-0002-AppendixS1-S8.docxWord document, 37.8 KB |
Table S1. ICD-9-CM Diagnosis Codes Used to Identify Alzheimer's Disease or Related Disorder (ADRD). Table S2. Antihypertensive Classes and Agents Included in Refill Adherence Calculations. Table S3. Covariate Balance Achieved After Applying Stabilized Inverse Probability of Treatment Weights. Table S4. Results of Multinomial Logistic Regression Model Comparing Odds of Membership in Mutually Exclusive MPR Categories, for Dual Prescription Users and Part D-only Users Relative to VA-only Users, Using 110% Cutoff for Oversupply (N = 50,763). Table S5. Results of Multinomial Logistic Regression Model Comparing Odds of Membership in MPR Categories, for Dual Prescription Users and Part D-only Users Relative to VA-only Users, Using Average Refill Adherence Values Across Classes (N = 50,763). Table S6. Results of Multinomial Logistic Regression Model Comparing Odds of Membership in Antihypertensive Medication Supply Categories, for Dual Prescription Users and Part D-only Users Relative to VA-only Users, in Medicaid/LIS Enrollees and Non-Enrollees. Table S7. Oral Hypoglycemic Agent (OHA) Use by VA Patients with Dementia and Diabetes, Overall and by OHA Medication User Group Status, 2010. Table S8. Results of Multinomial Logistic Regression Model Comparing Odds of Membership in Diabetes Medication Supply Categories, for Dual Prescription Users and Part D-only Users Relative to VA-only Users (N = 13,857). |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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