Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1058 — Patient Characteristics Associated with Receipt of Prescription Weight Management Medications Among Veterans in VA's MOVE! Weight Management Program

Lead/Presenter: Varsha Vimalananda, COIN - Bedford/Boston
All Authors: Vimalananda VG (CHOIR - Bedford VAMC) Waring ME (CHOIR - Bedford VAMC) Ameli O (CHOIR - Bedford VAMC) Berlowitz D (CHOIR - Bedford VAMC)

Objectives:
VA/DOD guidelines recommend weight management medications (WMMs) as an add-on treatment for patients not losing sufficient weight with behavioral intervention alone. Yet less than 1% of the nearly 5 million VA patients with overweight or obesity receive WMMs. We examined use of WMMs among VA patients enrolled in the MOVE! weight management program to understand which patients receive obesity pharmacotherapy in VA.

Methods:
We conducted a retrospective cohort study of VA patients enrolled in MOVE! in FY14-FY16 with body mass index (BMI)>=30kg/m2 or BMI > 27kg/m2 with obesity-related comorbidities at MOVE! enrollment. Logistic regression models estimated multivariable predictors of receipt of any WMM approved for long-term use (orlistat, lorcaserin, phentermine/topiramate, bupropion/naltrexone, liraglutide 3mg) or short-term use (phentermine).

Results:
Of the 153,892 veterans enrolled in MOVE!, 1.2% received a WMM. The commonest prescriptions were for orlistat (61%) and phentermine/topiramate (14%). WMM receipt was more likely among women (2.0% vs. 0.9%, aOR = 1.8, 95%CI = 1.6-2.0), patients with obesity (0.7% class I obesity vs. 0.5% overweight, aOR = 1.6, 95%CI = 1.3-2.0; 1.4% class II obesity, aOR = 2.9, 95% CI 2.3-3.6; 2.2% class III obesity, aOR = 4.5, 95%CI = 3.6-5.6), history of alcohol abuse (2.9% vs. 1.2% aOR = 2.3, 95%CI = 1.8-2.9), or history of substance abuse (2.0% vs. 1.2%, aOR = 1.6, 95%CI = 1.4-1.9). WMM receipt was also more likely among those with diabetes (1.3% vs. 1.2%, aOR = 1.2, 95%CI = 1.1-1.3), hyperlipidemia (1.2% vs. 1.2%, aOR = 1.1, 95%CI = 1.0-1.2), obstructive sleep apnea (1.7% vs. 1.0%, aOR = 1.3, 95%CI = 1.2-1.4), depression (aOR = 1.3, 95%CI = 1.2-1.4), osteoarthritis (1.5% vs. 1.1%, aOR = 1.2 95%CI = 1.1-1.3), and low back pain (1.5% vs. 1.1%, aOR = 1.2, 95%CI = 1.1-1.3). Age 65+ (0.8% vs. 1.3% 18-34 years, aOR = 0.6, 95%CI = 0.5-0.8) and copays (1.0% vs. 1.5%, aOR = 0.8, 95%CI = 0.7-0.8) were associated with lower odds of receipt of WMMs.

Implications:
WMMs are underutilized among patients engaged in behavioral weight management through VA. Several patient characteristics are associated with receipt of WMMs, especially greater degrees of obesity, history of alcohol or substance abuse, and female sex.

Impacts:
Only 1.2% of MOVE! participants are prescribed WMMs, but some types of patients are more likely to receive them. Identification of additional patient-, clinician-, and organization-level predictors of prescribing patterns and qualitative work to understand reasons for these patterns are needed. Findings can inform efforts to increase appropriate use of WMMs.