Dual Use of Department of Veterans Affairs and Medicare Benefits on High-Risk Opioid Prescriptions in Veterans Aged 65 Years and Older: Insights from the VA Musculoskeletal Disorders Cohort
Corresponding Author
Philip W. Chui M.D.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Department of Internal Medicine, Yale School of Medicine, New Haven, CT
Address correspondence to Philip W. Chui, M.D., Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516; and also Department of Internal Medicine, Yale School of Medicine, New Haven, CT; e-mail: [email protected].Search for more papers by this authorLori A. Bastian M.D., M.P.H.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Department of Internal Medicine, Yale School of Medicine, New Haven, CT
Search for more papers by this authorEric DeRycke M.P.H.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Search for more papers by this authorCynthia A. Brandt M.D., M.P.H.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
Search for more papers by this authorWilliam C. Becker M.D.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Department of Internal Medicine, Yale School of Medicine, New Haven, CT
Search for more papers by this authorJoseph L. Goulet Ph.D.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Search for more papers by this authorCorresponding Author
Philip W. Chui M.D.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Department of Internal Medicine, Yale School of Medicine, New Haven, CT
Address correspondence to Philip W. Chui, M.D., Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516; and also Department of Internal Medicine, Yale School of Medicine, New Haven, CT; e-mail: [email protected].Search for more papers by this authorLori A. Bastian M.D., M.P.H.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Department of Internal Medicine, Yale School of Medicine, New Haven, CT
Search for more papers by this authorEric DeRycke M.P.H.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Search for more papers by this authorCynthia A. Brandt M.D., M.P.H.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
Search for more papers by this authorWilliam C. Becker M.D.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Department of Internal Medicine, Yale School of Medicine, New Haven, CT
Search for more papers by this authorJoseph L. Goulet Ph.D.
Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
Search for more papers by this authorAbstract
Objective
To examine the association of dual use of both Veterans Health Administration (VHA) and Medicare benefits with high-risk opioid prescriptions among Veterans aged 65 years and older with a musculoskeletal disorder diagnosis.
Data Sources/Study Setting
Data were obtained from the VA Musculoskeletal Disorder (MSD) cohort and national Medicare claims data from 2008 to 2010.
Study Design
We conducted a retrospective analysis of Veterans enrolled in Medicare to examine the association of dual use with long-term opioid use (>90 days of prescription opioids/year) and overlapping opioid prescriptions. Multivariable logistic regression was performed adjusting for demographic and clinical characteristics.
Data Collection/Extraction Methods
We identified 21,111 Veterans enrolled in Medicare who entered the MSD cohort in 2008 and received an opioid prescription in 2010. We linked VHA data with Medicare claims data to identify opioid prescriptions for these Veterans in 2010.
Principal Findings
As compared to Veterans who used only VHA or Medicare, Veterans with dual use of VHA and Medicare were significantly more likely to be prescribed long-term opioid therapy (OR = 4.61 (95 percent CI 4.05–5.25) and were also found to have higher median number of opioid prescriptions and higher odds of overlapping opioid prescriptions in 1 year. Patients reporting moderate-to-severe pain, non-white-race/ethnicity, and higher scoring on the Charlson comorbidity index had significantly higher odds of long-term opioid prescriptions.
Conclusions
Among Veterans aged 65 years or older, dual use of both VHA and Medicare was associated with higher odds of long-term opioid therapy. Our findings suggest there may be benefit to combining VHA and non-VHA electronic health record data to minimize exposure to high-risk opioid prescribing.
Supporting Information
| Filename | Description |
|---|---|
| hesr13060-sup-0001-AppendixSA1.pdfPDF document, 1.5 MB | Appendix SA1: Author Matrix. |
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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