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Trends in Use of High-Risk Medications for Older Veterans: 2004 to 2006.

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Title: Trends in Use of High-Risk Medications for Older Veterans: 2004 to 2006.
Authors: Pugh, Mary Jo V., Hanlon, Joseph T., Wang, Chen-Pin, Semla, Todd, Burk, Muriel, Amuan, Megan E., Lowery, Ashlei, Good, Chester B., Berlowitz, Dan R.
Source: Journal of the American Geriatrics Society. Oct2011, Vol. 59 Issue 10, p1891-1898. 8p. 4 Charts, 1 Graph.
Subjects: Nitrofurans, Outpatient medical care, Analysis of variance, Databases, Drug utilization, Drug prescribing, Drug side effects, Health facilities, Health services accessibility, Health status indicators, Longitudinal method, Veterans, Research funding, United States. Dept. of Veterans Affairs, Physician practice patterns, Logistic regression analysis, Retrospective studies, Data analysis software, Old age, Therapeutics
Abstract: 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. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Trends in Use of High-Risk Medications for Older Veterans: 2004 to 2006.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Pugh%2C+Mary+Jo+V%2E%22&quot;&gt;Pugh, Mary Jo V.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hanlon%2C+Joseph+T%2E%22&quot;&gt;Hanlon, Joseph T.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Wang%2C+Chen-Pin%22&quot;&gt;Wang, Chen-Pin&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Semla%2C+Todd%22&quot;&gt;Semla, Todd&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Burk%2C+Muriel%22&quot;&gt;Burk, Muriel&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Amuan%2C+Megan+E%2E%22&quot;&gt;Amuan, Megan E.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Lowery%2C+Ashlei%22&quot;&gt;Lowery, Ashlei&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Good%2C+Chester+B%2E%22&quot;&gt;Good, Chester B.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Berlowitz%2C+Dan+R%2E%22&quot;&gt;Berlowitz, Dan R.&lt;/searchLink&gt;
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: OBJECTIVES: To examine the change in use of high-risk medications for the elderly (HRME), as defined by the National Committee on Quality Assurance&#39;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&lt;.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&lt;.001) reductions (range −3.8% to −16.0%); nitrofurantoin demonstrated a statistically significant increase (+36.5%; P&lt;.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. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=66674488
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/j.1532-5415.2011.03559.x
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      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 8
        StartPage: 1891
    Subjects:
      – SubjectFull: Nitrofurans
        Type: general
      – SubjectFull: Outpatient medical care
        Type: general
      – SubjectFull: Analysis of variance
        Type: general
      – SubjectFull: Databases
        Type: general
      – SubjectFull: Drug utilization
        Type: general
      – SubjectFull: Drug prescribing
        Type: general
      – SubjectFull: Drug side effects
        Type: general
      – SubjectFull: Health facilities
        Type: general
      – SubjectFull: Health services accessibility
        Type: general
      – SubjectFull: Health status indicators
        Type: general
      – SubjectFull: Longitudinal method
        Type: general
      – SubjectFull: Veterans
        Type: general
      – SubjectFull: Research funding
        Type: general
      – SubjectFull: United States. Dept. of Veterans Affairs
        Type: general
      – SubjectFull: Physician practice patterns
        Type: general
      – SubjectFull: Logistic regression analysis
        Type: general
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Data analysis software
        Type: general
      – SubjectFull: Old age
        Type: general
      – SubjectFull: Therapeutics
        Type: general
    Titles:
      – TitleFull: Trends in Use of High-Risk Medications for Older Veterans: 2004 to 2006.
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              Text: Oct2011
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