The Medicare Modernization Act of 2003 created a voluntary outpatient prescription drug benefit for Medicare enrollees through Part D. The drug benefit is available to all 43 million elderly and disabled Medicare beneficiaries who choose to enroll with prescription drug benefits beginning in January 2006. Previous research on Part D has not focused on the experiences of Veterans using multiple healthcare systems.
The primary objective of this pilot study was to design, edit, and validate a mail survey instrument including: review and edit the survey instrument using cognitive interviews with Veterans, describe the response rate and respondent characteristics, evaluate the internal consistency and validity of the survey, describe item non-response rates and distribution of item response categories and refine and finalize the survey instrument.
This pilot study utilized a cross sectional research design to test the survey instrument in a sample of Veterans employing the principles of the Tailored Design Method. First, the survey items were reviewed for content and edited. Second, the survey items were administered to Veterans and assessed using cognitive interviewing techniques to determine whether Veterans had an accurate understanding of the questions. The content review and cognitive interviews were conducted in collaboration with the University of Illinois at Chicago (UIC) Survey Research Laboratory using a sample of patients at the Jesse Brown VA Medical Center, Chicago IL. Third, 800 Medicare eligible Veterans who received health care at the Hines VA Hospital in 2009 were randomly sampled to receive the mail survey.
The initial survey instrument was constructed by a panel of clinicians, pharmacists and researchers. Cognitive interviews using the initial survey were conducted on eight Veterans and the instrument was further revised. The resulting survey was mailed to a random sample of 800 Veterans and 463 were returned. Twenty-one Veterans had missing or incorrect addresses, eleven were deceased, and three declined to participate for a response rate of 60.3%. Seventy-nine women Veterans (17.1%) and 384 men Veterans (82.9%) responded. On average, responding Veterans were 79 years of age, non-Hispanic (96.7%) and white (93.9%). The majority of Veterans had high school or greater education (88.6%) and were married (57.2%) or widowed (22.5%). Approximately 27.6% of respondents lived alone with the majority living with family, a friend, or spouse (68.4%). Non-responders were more likely to be female, non-white and single. Validation of survey responses using VA data sources (items such as gender, race, age, and marital status) revealed kappa coefficients ranging from moderately good (0.59) to very good (0.95). On average, Veterans skipped 1.18 required questions (std=2.04, median=0) with questions pertaining to income and wealth being most frequently skipped (11.1% and 14.2% respectively).
This pilot study validated a survey instrument that can be used in a subsequent research survey of Veterans.
- Stroupe KT, Smith BM, Hogan TP, St Andre JR, Gellad WF, Weiner S, Lee TA, Burk M, Cunningham F, Piette JD, Rogers TJ, Huo Z, Weaver FM. Medication acquisition across systems of care and patient-provider communication among older veterans. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2013 May 1; 70(9):804-13.