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CDA 09-207 – HSR&D Study

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CDA 09-207
Addressing Regional Variation in Drug Prescribing and Spending in the VA
Walid F. Gellad MD MPH
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
Pittsburgh, PA
Funding Period: June 2010 - May 2015

BACKGROUND/RATIONALE:
Diabetes is highly prevalent among Veterans, and we have previously documented substantial variation in the use of high-cost diabetes and lipid-lowering drugs across the VA. This research will extend our prior work by validating the measurement of variation and understanding its relationship to quality of care by adjusting for important patient and facility variables. Because of the importance of geography in understanding racial disparities, we will also apply these methods to the study of racial disparities in medication use.

OBJECTIVE(S):
(1) To conduct an analysis of regional variation in prescription use and spending for patients with diabetes across the VA and to assess the association between prescription spending and quality of care. (2) To determine if racial/ethnic disparities in prescription use exist among patients with diabetes and to understand how these disparities may vary by geographic region.

METHODS:
Our study population is the cohort of adult Veterans with type 2 diabetes who were managed in the VA in fiscal year 2009. We have obtained individual-level data including demographics, comorbidity, and pharmacy use for our cohort from both VA and Medicare/Medicaid through 2010. We are comparing prescription use and spending on oral hypoglycemic and insulin medications and supplies, statins, and antihypertensives across VA facilities and across regions. We are modeling the relationship between prescription spending and quality of care using a number of patient-level and facility-level quality measures and hierarchical modeling. We will test whether racial/ethnic disparities exist in medication use among patients with diabetes nationally and quantify the amount of variation explained by clustering across facilities and across regions.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Diabetes is highly prevalent among Veterans and addressing variation in prescribing is a key component of improving quality of care and bringing efficiency to VA. Our findings thus far suggest that while they may exert powerful effects on medication choice, formularies and utilization management tools can only go so far in standardizing health care delivery. Our findings highlight opportunities to improve the cost-effectiveness of prescribing within VA, as well as within Medicare and also highlight the challenges for efficiency, quality, and safety when Veterans use multiple health systems for their care.

PUBLICATIONS:

Journal Articles

  1. Marcum ZA, Bellon JE, Li J, Gellad WF, Donohue JM. New chronic disease medication prescribing by nurse practitioners, physician assistants, and primary care physicians: a cohort study. BMC health services research. 2016 Jul 27; 16(1):312.
  2. Lo-Ciganic WH, Gellad WF, Gordon AJ, Cochran G, Zemaitis MA, Cathers T, Kelley D, Donohue JM. Association between trajectories of buprenorphine treatment and emergency department and in-patient utilization. Addiction (Abingdon, England). 2016 May 1; 111(5):892-902.
  3. Radomski TR, Zhao X, Thorpe CT, Thorpe JM, Good CB, Mor MK, Fine MJ, Gellad WF. VA and Medicare Utilization Among Dually Enrolled Veterans with Type 2 Diabetes: A Latent Class Analysis. Journal of general internal medicine. 2016 May 1; 31(5):524-31.
  4. Stroupe KT, Bailey L, Gellad WF, Suda K, Huo Z, Martinez R, Burk M, Cunningham F, Smith BM. Veterans' Pharmacy and Health Care Utilization Following Implementation of the Medicare Part D Pharmacy Benefit. Medical care research and review : MCRR. 2017 Jun 1; 74(3):328-344.
  5. Tang Y, Chang CC, Lave JR, Gellad WF, Huskamp HA, Donohue JM. Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior. Journal of Mental Health Policy and Economics. 2016 Mar 1; 19(1):45-59.
  6. Lee JS, Giesler DL, Gellad WF, Fine MJ. Antibiotic Therapy for Adults Hospitalized With Community-Acquired Pneumonia: A Systematic Review. JAMA. 2016 Feb 9; 315(6):593-602.
  7. Radomski TR, Good CB, Thorpe CT, Zhao X, Marcum ZA, Glassman PA, Lowe J, Mor MK, Fine MJ, Gellad WF. Variation in Formulary Management Practices Within the Department of Veterans Affairs Health Care System. Journal of managed care & specialty pharmacy. 2016 Feb 1; 22(2):114-20.
  8. Anderson TS, Good CB, Gellad WF. Prevalence and compensation of academic leaders, professors, and trustees on publicly traded US healthcare company boards of directors: cross sectional study. BMJ (Clinical research ed.). 2015 Sep 29; 351:h4826.
  9. Lo-Ciganic WH, Donohue JM, Thorpe JM, Perera S, Thorpe CT, Marcum ZA, Gellad WF. Using machine learning to examine medication adherence thresholds and risk of hospitalization. Medical care. 2015 Aug 1; 53(8):720-8.
  10. Lund BC, Carrel M, Gellad WF, Chrischilles EA, Kaboli PJ. Incidence- Versus Prevalence-Based Measures of Inappropriate Prescribing in the Veterans Health Administration. Journal of the American Geriatrics Society. 2015 Aug 1; 63(8):1601-7.
  11. Donohue JM, Papademetriou E, Henderson RR, Frazee SG, Eibner C, Mulcahy AW, Mehrotra A, Bharill S, Cui C, Stein BD, Gellad WF. Early Marketplace Enrollees Were Older And Used More Medication Than Later Enrollees; Marketplaces Pooled Risk. Health affairs (Project Hope). 2015 Jun 1; 34(6):1049-56.
  12. Thorpe CT, Gellad WF, Good CB, Zhang S, Zhao X, Mor M, Fine MJ. Tight glycemic control and use of hypoglycemic medications in older veterans with type 2 diabetes and comorbid dementia. Diabetes Care. 2015 Apr 1; 38(4):588-95.
  13. Marcum ZA, Driessen J, Thorpe CT, Donohue JM, Gellad WF. Regional variation in use of a new class of antidiabetic medication among medicare beneficiaries: the case of incretin mimetics. The Annals of pharmacotherapy. 2015 Mar 1; 49(3):285-92.
  14. Prentice JC, Conlin PR, Gellad WF, Edelman D, Lee TA, Pizer SD. Long-term outcomes of analogue insulin compared with NPH for patients with type 2 diabetes mellitus. The American journal of managed care. 2015 Mar 1; 21(3):e235-43.
  15. Cochran G, Woo B, Lo-Ciganic WH, Gordon AJ, Donohue JM, Gellad WF. Defining nonmedical use of prescription opioids within health care claims: a systematic review. Substance Abuse. 2015 Feb 11; 36(2):192-202.
  16. Zullig LL, Gellad WF, Moaddeb J, Crowley MJ, Shrank W, Granger BB, Granger CB, Trygstad T, Liu LZ, Bosworth HB. Improving diabetes medication adherence: successful, scalable interventions. Patient preference and adherence. 2015 Jan 23; 9:139-49.
  17. Gellad WF, Zhao X, Thorpe CT, Mor MK, Good CB, Fine MJ. Dual use of Department of Veterans Affairs and medicare benefits and use of test strips in veterans with type 2 diabetes mellitus. JAMA internal medicine. 2015 Jan 1; 175(1):26-34.
  18. Hanlon JT, Aspinall SL, Handler SM, Gellad WF, Stone RA, Semla TP, Pugh MJ, Dysken MW. Potentially suboptimal prescribing for older veteran nursing home patients with dementia. The Annals of pharmacotherapy. 2015 Jan 1; 49(1):20-8.
  19. Prentice JC, Conlin PR, Gellad WF, Edelman D, Lee TA, Pizer SD. Capitalizing on prescribing pattern variation to compare medications for type 2 diabetes. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 2014 Dec 1; 17(8):854-62.
  20. Crandall CJ, Newberry SJ, Diamant A, Lim YW, Gellad WF, Booth MJ, Motala A, Shekelle PG. Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Annals of internal medicine. 2014 Nov 18; 161(10):711-23.
  21. Gellad WF, Stein BD, Ruder T, Henderson R, Frazee SG, Mehrotra A, Donohue JM. Geographic variation in receipt of psychotherapy in children receiving attention-deficit/hyperactivity disorder medications. JAMA pediatrics. 2014 Nov 1; 168(11):1074-6.
  22. Tang Y, Gellad WF, Men A, Donohue JM. Impact of medicare part D plan features on use of generic drugs. Medical care. 2014 Jun 1; 52(6):541-8.
  23. Anderson TS, Dave S, Good CB, Gellad WF. Academic medical center leadership on pharmaceutical company boards of directors. JAMA. 2014 Apr 2; 311(13):1353-5.
  24. Gellad WF, Choi P, Mizah M, Good CB, Kesselheim AS. Assessing the chiral switch: approval and use of single-enantiomer drugs, 2001 to 2011. The American journal of managed care. 2014 Mar 1; 20(3):e90-7.
  25. Marcum ZA, Driessen J, Thorpe CT, Gellad WF, Donohue JM. Effect of multiple pharmacy use on medication adherence and drug-drug interactions in older adults with Medicare Part D. Journal of the American Geriatrics Society. 2014 Feb 1; 62(2):244-52.
  26. Borrero S, Zhao X, Mor MK, Schwarz EB, Good CB, Gellad WF. Adherence to hormonal contraception among women veterans: differences by race/ethnicity and contraceptive supply. American journal of obstetrics and gynecology. 2013 Aug 1; 209(2):103.e1-11.
  27. Gellad WF, Donohue JM, Zhao X, Mor MK, Thorpe CT, Smith J, Good CB, Fine MJ, Morden NE. Brand-name prescription drug use among Veterans Affairs and Medicare Part D patients with diabetes: a national cohort comparison. Annals of internal medicine. 2013 Jul 16; 159(2):105-14.
  28. 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.
  29. Gellad W, Mor M, Zhao X, Donohue J, Good C. Variation in use of high-cost diabetes mellitus medications in the VA healthcare system. Archives of internal medicine. 2012 Nov 12; 172(20):1608-9.
  30. Gellad WF, Aspinall SL, Handler SM, Stone RA, Castle N, Semla TP, Good CB, Fine MJ, Dysken M, Hanlon JT. Use of antipsychotics among older residents in VA nursing homes. Medical care. 2012 Nov 1; 50(11):954-60.
  31. Zhang Y, Gellad WF, Zhou L, Lin YJ, Lave JR. Access to and use of $4 generic programs in Medicare. Journal of general internal medicine. 2012 Oct 1; 27(10):1251-7.
  32. Donohue JM, Marcum ZA, Gellad WF, Lave JR, Men A, Hanlon JT. Medicare Part D and potentially inappropriate medication use in the elderly. The American journal of managed care. 2012 Sep 1; 18(9):e315-22.
  33. Thorpe JM, Thorpe CT, Kennelty KA, Gellad WF, Schulz R. The impact of family caregivers on potentially inappropriate medication use in noninstitutionalized older adults with dementia. The American journal of geriatric pharmacotherapy. 2012 Aug 1; 10(4):230-41.
  34. Gellad WF, Good CB, Amuan ME, Marcum ZA, Hanlon JT, Pugh MJ. Facility-level variation in potentially inappropriate prescribing for older veterans. Journal of the American Geriatrics Society. 2012 Jul 1; 60(7):1222-9.
  35. Marcum ZA, Gellad WF. Medication adherence to multidrug regimens. Clinics in geriatric medicine. 2012 May 1; 28(2):287-300.
  36. Donohue JM, Morden NE, Gellad WF, Bynum JP, Zhou W, Hanlon JT, Skinner J. Sources of regional variation in Medicare Part D drug spending. The New England journal of medicine. 2012 Feb 9; 366(6):530-8.
  37. Gellad WF, Donohue JM, Zhao X, Zhang Y, Banthin JS. The financial burden from prescription drugs has declined recently for the nonelderly, although it is still high for many. Health affairs (Project Hope). 2012 Feb 1; 31(2):408-16.
  38. Gellad WF, Huskamp HA, Li A, Zhang Y, Safran DG, Donohue JM. Use of prescription drug samples and patient assistance programs, and the role of doctor-patient communication. Journal of general internal medicine. 2011 Dec 1; 26(12):1458-64.
  39. Grenard JL, Munjas BA, Adams JL, Suttorp M, Maglione M, McGlynn EA, Gellad WF. Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. Journal of general internal medicine. 2011 Oct 1; 26(10):1175-82.
  40. Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. The American journal of geriatric pharmacotherapy. 2011 Feb 1; 9(1):11-23.
  41. Zhang Y, Donohue JM, Lave JR, Gellad WF. The impact of Medicare Part D on medication treatment of hypertension. Health services research. 2011 Feb 1; 46(1 Pt 1):185-98.
  42. Gellad WF, Good CB, Lowe JC, Donohue JM. Variation in prescription use and spending for lipid-lowering and diabetes medications in the Veterans Affairs Healthcare System. The American journal of managed care. 2010 Oct 1; 16(10):741-50.
Journal Other

  1. Baksh SN, Gellad WF, Alexander GC. Maximizing the Post-Approval Safety of Flibanserin: A Role for Regulators, Clinicians, and Patients. [Editorial]. Drug Safety. 2016 May 1; 39(5):375-80.
  2. Good CB, Gellad WF. Off-label Drug Use and Adverse Drug Events: Turning up the Heat on Off-label Prescribing. JAMA internal medicine. 2016 Jan 1; 176(1):63-4.
  3. Rocco P, Gellad WF, Donohue JM. Modernizing Medicaid Managed Care: Can States Meet the Data Challenges? [Editorial]. JAMA : the journal of the American Medical Association. 2015 Oct 20; 314(15):1559-60.
  4. Gellad WF, Flynn KE, Alexander GC. Evaluation of Flibanserin: Science and Advocacy at the FDA. JAMA : the journal of the American Medical Association. 2015 Sep 1; 314(9):869-70.
  5. Tang Y, Chang CH, Huskamp H, Gellad WF, Donohue JM. The concentration of antipsychotic prescribing: evidence from Medicaid. [Abstract]. Value in health : the journal of the International Society for Pharmacoecon. 2015 May 1; 18(3):A128.
  6. Gordon AJ, Lo Ciganic W, Cochran G, Gellad WF, Donohue JM. Characteristics of buprenorphine opioid agonist treatment in a longitudinal US Medicaid population. [Abstract]. Drug and Alcohol Dependence. 2015 Jan 1; 146:E126.
  7. Anderson TS, Good CB, Gellad WF. Potential conflicts of interest for academic medical center leaders--reply. [Letter to the Editor]. JAMA : the journal of the American Medical Association. 2014 Aug 6; 312(5):558-9.
  8. Lo-Ciganic W, Donohue JM, Thorpe CT, Thorpe JM, Perera S, Marcum ZA, Gellad WF. Examining a threshold of adherence to oral hypoglycemic agents relevant to clinical outcomes in diabetes: a tree-structured survival model. [Abstract]. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 2014 May 1; 17(3):A253.
  9. Gellad WF. Targeted cancer therapy: from bench to bedside to patient. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2014 Feb 1; 32(4):268-70.
  10. James AE, Gellad WF, Primack BA. Implications of new insurance coverage for access to care, cost-sharing, and reimbursement. JAMA : the journal of the American Medical Association. 2014 Jan 15; 311(3):241-2.
  11. Anderson TS, Good CB, Gellad WF. Macitentan and pulmonary arterial hypertension. [Letter to the Editor]. The New England journal of medicine. 2014 Jan 2; 370(1):81.
  12. Gellad WF, Yealy D, Fine M. Computers and the diagnosis of pneumonia. JAMA internal medicine. 2013 Apr 22; 173(8):701-2.
  13. Gellad WF. What certification really means for physician quality [invited perspective]. American Health and Drug Benefits. 2011 Dec 1; 4(7).
  14. Gellad WF, Good CB. Angiotensin receptor blockers (ARBs). [Letter to the Editor]. CMAJ: Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne. 2011 Apr 19; 183(7):826.
  15. Gellad WF. When more is almost always better. American Health and Drug Benefits. 2011 Apr 1; 4(2):99-100.
  16. Zhang Y, Zhou L, Gellad WF. Potential savings from greater use of $4 generic drugs. [Letter to the Editor]. Archives of internal medicine. 2011 Mar 14; 171(5):468-9.
Books

  1. Crandall CJ, Newberry SJ, Diamant A, Lim YW, Gellad WF, Suttorp MJ, Motala A, Ewing B, Roth B, Shanman R, Timmer M, Shekelle PG. Treatment to prevent fractures in men and women with low bone density or osteoporosis: update of a 2007 report. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012.
  2. Gellad WF, Maggard Gibbons M, Miake-Lye IM, Shekelle PG. A Comparison of Joint Replacement Disparities in VA and Non-VA Settings: A Systematic Review. Washington (DC): Department of Veterans Affairs (US); 2011. 59 p.
Book Chapters

  1. Choi P, Gellad WF. Prescription drugs and pharmaceuticals. In: Sethi MK, Frist WH, editors. An Introduction to Health Policy: A Primer for Physicians and Medical Students. New York, NY: Springer; 2013. Chapter 9. 101-118 p.
Magazine/Popular Press Articles

  1. Mooney BL, Gellad WF. Despite formulary, high-cost diabetes drug use varies widely across VA facilities. US Medicine. 2012 Nov 1; 48(11):1-8.
Reports

  1. Donohue JM, Lo-Ciganic WH, Cochran G, Gordon AJ, Zemaitis MA, Gellad WF. Opioid use, opioid use disorder and buprenorphine use in Pennsylvania Medicaid. Philadelphia, PA: Commonwealth of Pennsylvania Department of Public Welfare, Office of Medical Assistance Programs; 2014 Mar 31. 42 p.
  2. Donohue JM, Tang Y, Gellad WF. Antipsychotic prescribing and use in Pennsylvania Medicaid. Philadelphia, PA: Commonwealth of Pennsylvania Department of Public Welfare, Office of Medical Assistance Programs; 2014 Mar 1. 37 p.
  3. Gellad WF, Grenard J, McGlynn EA. A review of barriers to medication adherence: a framework for driving policy options. RAND; 2009 Oct 1. Report No.: TR-765-MVC.
HSR&D or QUERI Articles

  1. Gellad WF. Value and efficiency in the context of dual use. HSR&D Forum. 2015 Aug 17; 6.
Center Products

  1. Gellad WF. An inexpensive prescription for Medicare (The RAND Blog). 2013 Nov 18.
VA Cyberseminars

  1. Asch S, Blonigen D, Cucciare M, Gellad WF, Keyhani S. Transitioning off CDA and Factors Influencing Retention. HSR&D Career Development Awardee Series [Cyberseminar]. HSR&D. 2016 Apr 12.
  2. Gellad WF, Zhao X. Examining Veterans’ pharmacy use with VA and Medicare pharmacy data [VIReC Database and Methods Seminar]. [Cyberseminar]. 2015 Jun 29.
  3. Gellad WF, Shekelle P, Gibbons MM. A comparison of joint replacement disparities in VA and non-VA settings [Spotlight on Evidence-based Synthesis Program]. [Cyberseminar]. 2011 Oct 8.
Conference Presentations

  1. Lo-Ciganic W, Donohue JM, Thorpe JM, Perera S, Thorpe CT, Marcum ZA, Gellad WF. Using machine learning to examine medication adherence thresholds and risk of hospitalization. Paper presented at: Pharmacoepidemiology and Therapeutic Risk Management Annual International Conference; 2015 Aug 24; Boston, MA.
  2. Lo-Ciganic W, Gellad WF, Gordon AJ, Cochran G, Donohue JM. Trajectories of buprenorphine treatment and associated emergency department and inpatient use in a large Medicaid program. Paper presented at: Pharmacoepidemiology and Therapeutic Risk Management Annual International Conference; 2015 Aug 24; Boston, MA.
  3. Radomski T, Zhao X, Thorpe CT, Good CB, Mor MK, Fine MJ, Gellad WF. Typologies of VA and Medicare utilization among dually enrolled Veterans with type 2 diabetes: a latent class analysis. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 10; Philadelphia, PA.
  4. Stroupe KT, Bailey LA, Gellad WF, Suda KJ, Huo Z, Martinez RM, Burk ML, Cunningham F, Smith BM. Veterans' pharmacy and healthcare utilization following implementation of the Medicare Part D pharmacy benefit. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  5. Suda KJ, Bailey LA, Smith BM, Gellad WF, Huo Z, Cunningham F, Burk M, Stroupe KT. Opioid use in Veterans eligible for VA and Medicare Part D and predictors for overlap within and among VA and Medicare Part D-reimbursed pharmacies. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  6. Anderson T, Gellad WF, Zhang R, Huskamp H, Choudry N, Chang CH, Richards-Shubik S, Guclu H, Donohue J. Physician Adoption of New Drugs: Identifying Rapid Adopters Selective Adopters, and Conservative Prescribers. Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 15; Minneapolis, MN.
  7. Lo-Ciganic W, Gellad WF, Gordon AJ, Cochran G, Donohue JM. Associations between buprenorphine treatment trajectories and clinical outcomes in a large Medicaid program. Poster session presented at: College on Problems of Drug Dependence Annual Meeting; 2015 Jun 15; Phoenix, AZ.
  8. Lo-Ciganic W, Gellad WF, Gordon AJ, Cochran G, Donohue JM. Trajectories of buprenorphine treatment and associated emergency department and inpatient use in a large Medicaid program. Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 15; Minneapolis, MN.
  9. Lo-Ciganic W, Donohue JM, Jones B, Thorpe JM, Perera S, Thorpe CT, Marcum ZA, Gellad WF. Trajectories of oral hypoglycemic treatment and associated inpatient use in a large Medicaid program. Poster session presented at: University of Pittsburgh Center for Pharmaceutical Policy and Prescribing Conference on the Science of Medication Adherence; 2015 Jun 2; Pittsburgh, PA.
  10. Lo-Cignac WH, Gordon AJ, Donohue JM, Gellad WF, Cochran G. Trajectories of buprenorphine treatment and associated emergency department and inpatient use in a large Medicaid program. Paper presented at: University of Pittsburgh Center for Pharmaceutical Policy and Prescribing Conference on the Science of Medication Adherence; 2015 Jun 2; Pittsburgh, PA.
  11. Lo-Cignac WH, Jones B, Perera S, Marcum ZA, Donohue JM, Thorpe JM, Thorpe CT, Gellad WF. Using machine learning to examine medication adherence thresholds and risk of hospitalization. Paper presented at: University of Pittsburgh Center for Pharmaceutical Policy and Prescribing Conference on the Science of Medication Adherence; 2015 Jun 2; Pittsburgh, PA.
  12. Lo-Ciganic W, Gellad WF, Gordon AJ, Donohue JM, Cochran G. Trajectories of buprenorphine treatment and associated emergency department and inpatient use in a large Medicaid program. Poster session presented at: International Society for Pharmacoeconomics and Outcomes Research Annual Meeting; 2015 May 19; Philadelphia, PA.
  13. Tan Y, Chang CH, Lave JR, Gellad WF, Huskamp HA, Donohue JM. Patient, physician and organizational influences on the concentration of antipsychotic prescribing in a large Medicaid program. Poster session presented at: International Society for Pharmacoeconomics and Outcomes Research Annual Meeting; 2015 May 19; Philadelphia, PA.
  14. Tan Y, Horvitz-Lennon M, Gellad WF, Normand SL, Donohue JM. Prescribing of clozapine and antipsychotic polypharmacy for schizophrenia in a large Medicaid program. Poster session presented at: International Society for Pharmacoeconomics and Outcomes Research Annual Meeting; 2015 May 19; Philadelphia, PA.
  15. Radomski T, Zhao X, Thorpe CT, Good CB, Mor MK, Fine MJ, Gellad WF. Patterns of VA and Medicare utilization among dually enrolled Veterans with type 2 diabetes: a latent class analysis. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2015 Apr 24; Toronto, Canada.
  16. Harrigan K, Thorpe JM, Gellad W, Marcum Z, Hanlon JT. Racial and ethnic disparities in analgesic prescribing for migraine in US emergency departments. Poster session presented at: American Public Health Association Annual Meeting and Exposition; 2014 Nov 17; New Orleans, LA.
  17. Cochran G, Woo B, Donohue J, Gordon A, Lo-Ciganic W, Gellad W. Defining non-medical use of prescription opioids within health insurance claims data: a systematic review. Paper presented at: Association for Medical Education and Research in Substance Abuse Annual Meeting; 2014 Nov 7; San Francisco, CA.
  18. Gordon AJ, Lo Ciganic W, Cochran G, Gellad WF, Donohue JM. Characteristics of buprenorphine opioid agonist treatment in a longitudinal US Medicaid Population. Poster session presented at: College on Problems of Drug Dependence Annual Meeting; 2014 Jun 16; San Juan, Puerto Rico.
  19. Gellad WF. Using "big data" to understand physician prescribing and financial relationships. Presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.
  20. Lo-Ciganic W, Thorpe JM, Perera KS, Marcum ZA, Donohue JM, Thorpe CT, Gellad WF. Examining a threshold of adherence to oral hypoglycemic agents relevant to clinical outcomes in diabetes: a tree-structured survival model. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.
  21. Lo-Ciganic W, Donohue JM, Perera S, Thorpe CT, Marcum ZA, Gellad WF. Examining a threshold of adherence to oral hypoglycemic agents relevant to clinical outcomes in diabetes: a tree-structured survival model. Poster session presented at: International Society for Pharmacoeconomics and Outcomes Research Annual Meeting; 2014 Jun 4; Montreal, Canada.
  22. Marcum ZA, Driessen JR, Thorpe CT, Donohue JM, Gellad WF. Geographic variation in uptake of a novel drug class: the case of incretin mimetics. Poster session presented at: American Geriatrics Society Annual Meeting; 2014 May 16; Orlando, FL.
  23. Thorpe CT, Obrosky DS, Zhao X, Gellad WF, Hanlon JT. Tight glycemic control, use of high-risk hypoglycemic medications, and associated factors in older VA nursing home residents with diabetes and comorbid dementia. Poster session presented at: American Geriatrics Society Annual Meeting; 2014 May 16; Orlando, FL.
  24. Anderson TS, Donohue JM, Morden NE, Zhao X, Mor MK, Thorpe CT, Good CB, Fine MJ, Gellad WF. Regional correlation in brand-name prescription drug use among VA and Medicare Part D patients with diabetes. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 25; San Diego, CA.
  25. Gellad WF. Prescribing efficiency. Presented at: VA HSR&D Career Development Annual Meeting; 2014 Feb 1; Arlington, VA.
  26. Thorpe CT, Gellad WF, Good CB, Zhang S, Zhao X, Mor MK, Fine MJ. Tight glycemic control and use of hypoglycemic medications in older Veterans with type 2 diabetes and comorbid dementia. Poster session presented at: Gerontological Society of America Annual Scientific Meeting; 2013 Nov 22; New Orleans, LA.
  27. Gellad WF. Brand-name prescription drug use among diabetes patients in Medicare Part D and the VA: a national comparison. Presented at: Medicare Payment Advisory Commission Meeting; 2013 Sep 19; Washington, DC.
  28. Prentice J, Conlin P, Edelman D, Gellad WF, Lee T, Pizer S. Are there long-term benefits to prescribing long-acting analogue insulin compared to human insulin? Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 25; Baltimore, MD.
  29. Tang Y, Gellad WF, Men A, Donohue JM. Regional variation in use of generic drugs and Medicare Part D cost sharing. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 25; Baltimore, MD.
  30. Gellad WF, Donohue J, Zhao X, Mor MK, Thorpe CT, Good CB, Fine MJ, Morden N. Brand-name prescription drug use among diabetes patients in Medicare Part D and the VA: a national comparison. Paper presented at: AcademyHealth Annual Research Meeting; 2013 Jun 24; Baltimore, MD.
  31. Pizer S, Prentice J, Gellad WF, Conlin P. Long-term sulfonylurea use increases risks among patients with type 2 diabetes. Paper presented at: AcademyHealth Annual Research Meeting; 2013 Jun 24; Baltimore, MD.
  32. Borrero SB, Zhao X, Mor MK, Schwarz EB, Good CB, Gellad WF. Adherence to hormonal contraception among women Veterans: differences by race/ethnicity and contraceptive supply. Paper presented at: Society of General Internal Medicine Annual Meeting; 2013 Apr 24; Denver, CO.
  33. Borrero SB, Schwarz EB, Zhao X, Mor MK, Gellad WF. Contraceptive adherence in the VA Healthcare System. Poster session presented at: Society of Family Planning North American Forum on Family Planning; 2012 Oct 6; Denver, CO.
  34. Gellad WF, Good CB, Amuan ME, Marcum ZA, Hanlon JT, Pugh MJ. Facility-level variation in the quality of prescribing for older Veterans. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 17; National Harbor, MD.
  35. Gellad WF. Optimizing patient adherence: solutions that work [invited keynote address]. Presented at: University of Chicago Pritzker School of Medicine Comprehensive Review of the Management of Hypertension Annual Meeting; 2011 Oct 29; Chicago, IL.
  36. Gellad WF. Trends in the financial burden of prescription drugs among the non-elderly, 1997-2008. Paper presented at: AcademyHealth Annual Research Meeting; 2011 Jun 13; Seattle, WA.
  37. Gellad WF, Mor MK, Zhao X, Donohue JM, Good CB, Fine MJ. Variation in prescription use among patients with diabetes in the VA Healthcare System. Paper presented at: Society of General Internal Medicine Annual Meeting; 2011 May 5; Phoenix, AZ.
  38. Gellad WF, Aspinall SL, Handler SM, Stone RA, Castle N, Semla TP, Good CB, Dysken M, Hanlon JT. Antipsychotic prescribing in older Veterans Administration community living center patients. Paper presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.
  39. Gellad WF, Lowe J, Good CB, Donohue J. Use of angiotensin receptor blockers in the VA, 2000-2009 – why so much variation? Paper presented at: AcademyHealth Annual Research Meeting; 2010 Jun 28; Boston, MA.
  40. Donohue J, Marcum Z, Zhang Y, Men A, Gellad WF, Hanlon JT. Medicare Part D’s impact on use of high risk medications among older adults. Paper presented at: AcademyHealth Annual Research Meeting; 2010 Jun 27; Boston, MA.
  41. Gellad WF. Prescribing efficiently and safely: quality of care for prescription drugs. Presented at: AcademyHealth Annual Research Meeting; 2010 Jun 27; Boston, MA.
  42. Gellad WF, Donohue J, Zhao X, Banthin J. Trends in the financial burden of prescription drugs among the non-elderly, 1999-2007. Paper presented at: AcademyHealth Annual Research Meeting; 2010 Jun 13; Seattle, WA.
  43. Gellad WF, Good CB, Lowe J, Donohue J. Use of angiotensin receptor blockers in the VA, 2000-2009 – why so much variation? Paper presented at: Society of General Internal Medicine Annual Meeting; 2010 May 1; Minneapolis, MN.
  44. Donohue J, Huskamp H, Zhang Y, Safran D, Gellad WF. Use of free medicine samples, doctor patient communication and cost-related non-adherence among older adults. Poster session presented at: International Society for Pharmacoeconomics and Outcomes Research Annual European Congress; 2009 Oct 25; Paris, France.
  45. Donohue JM, Zhang Y, Lave J, Gellad WF, Perera S, Men A, Hanlon JT. Impact of expanding pharmacy benefits on treatment of congestive heart failure: the case of Medicare Part D. Poster session presented at: International Society for Pharmacoeconomics and Outcomes Research Annual European Congress; 2009 Oct 25; Paris, France.


DRA: Health Systems, Diabetes and Other Endocrine Disorders
DRE: Epidemiology, Treatment - Observational, Prognosis
Keywords: Pharmaceuticals, Practice patterns
MeSH Terms: none

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