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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1065 — Medication Acquisition from VA and Non-VA Pharmacies by Elderly Veterans

Stroupe KTSt. Andre JRHogan TP, and Smith BM, Hines VA Hospital;

Objectives:
Prescription medications are at the core of managing and treating chronic illnesses, particularly for patients with multiple conditions. The availability of the Medicare Part D pharmacy benefit may increase flexibility and options in obtaining medications; however, the availability of non-VA medication coverage might also complicate medication management and adherence. This study examined medication acquisition from VA and non-VA pharmacies among senior Veterans after the availability of Medicare Part D.

Methods:
Eight hundred Veterans from a single, Midwestern VA medical center were mailed a survey utilizing the Tailored Design Method. To be included, Veterans had to be Medicare eligible (i.e., >=65 years of age) and have healthcare utilization at the VA medical center in 2008. This study oversampled women (20%) and adjusted for this in subsequent analyses.

Results:
There was a 60.3% response rate for the survey. Respondents averaged 79 years of age and were predominantly non-Hispanic (96.7%) and white (93.9%) with high school or greater education (88.6%) and were married (57.2%) or widowed (22.5%). Approximately 56% of Veterans reported non-VA insurance to help pay for medication costs, with 24% having Medicare Part D. Ninety-four percent reported taking >=1 prescription medication regularly (average = 6, SD = 3.68). 48.8% reported having >=1 non-VA physician office visit in the previous year and 52.9% reported filling prescription medications at non-VA pharmacies. At least one chronic condition was reported by 93.2% of Veterans (notably, 74.5% with hyperlipidemia and 77.1% with hypertension), and 27.8% of Veterans reported treating >=1 chronic condition using medication(s) prescribed by both VA and non-VA providers for that condition. Among the 52.9% of Veterans filling prescription medications at non-VA pharmacies, 42.7% reported that they never discussed non-VA medications with their VA healthcare providers and 17.7% only discussed non-VA medications with VA providers at a few of their visits.

Implications:
Medicare-eligible Veterans often take multiple medications and frequently utilize non-VA services and pharmacies. Moreover, many Veterans are not discussing their non-VA medications with VA healthcare providers, thereby complicating medication reconciliation.

Impacts:
VA physicians and pharmacists must continue to inquire about non-VA healthcare and medication utilization to avoid adverse events as medication reconciliation continues to be a VA priority.


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