Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3020 — Comparison of Rates of Inappropriate Medications in a VA and Private Sector Population

Author List:
Barnett MJ (CRIISP, Touro College of Pharmacy)
Langstaff JD (CRIISP, University of Iowa College of Pharmacy)
Perry PJ (Touro College of Pharmacy)
Kaboli PJ (CRIISP, University of Iowa College of Medicine)

Objectives:
Previous research has suggested the number of older adults on inappropriate medications ranges from 12% to 40%. It is unknown whether the VA has lower rates of inappropriate use when compared to the private sector. This study directly compares rates of inappropriate medication use between VA and private sector populations.

Methods:
VA administrative files (OPC, DSS pharmacy data) were used to identify outpatients (N=123,633) with VA prescription drug coverage, aged 65 and older, from 10 distinct geographical regions, for an 18-month period (April 1, 2002-September 30, 2003). Results for patients 65 and older (N=157,517) enrolled in Medicare HMOs in 10 analogous regions for a similar 18-month period were obtained from a recently published article. Inappropriate medication use was classified using the Beers criteria, which categorizes 33 inappropriate drugs into three major classes: always avoid, rarely appropriate, and some indication. Overall comparisons between the VA and the private sector were performed. Comparisons stratifying by gender and age were also conducted.

Results:
Compared to private sector patients, VA patients were less likely to receive any inappropriate medication (21% vs. 29%; p<.001), as well as each classification: always avoid (2% vs. 5%; p<.001), rarely appropriate (8% vs. 13%; p<.001), and some indication (15% vs. 17%; p<.001). Stratified by gender, the rate of inappropriate drug use was lower in VA compared to the private sector for both males (21% vs. 24%;p<.001) and females (28% vs. 32%; p<.001). Stratified by age, the rate of inappropriate use was lower in VA patients age 65-74 (22% vs. 28%; p<.001) and 75 and older (21% vs. 30%; p<.001), compared to the private sector.

Implications:
Comparing a recent sample of elderly private sector and VA patients across a wide range of geographical regions for comparable 18 month time frames, VA patients were less likely to receive inappropriate (Beers) medications.

Impacts:
These findings add to the body of literature that suggests the VA may deliver higher quality of outpatient care than private sector delivery systems. Future studies may examine reasons for the differences, which may include computerized order entry, integrated electronic medical records, and a centralized formulary within the VA.