Many Older Veterans Do Not Discuss Non-VA Medications with VA Providers, Complicating Medication Reconciliation
In January 2006, outpatient prescription drug coverage became available for the first time through Medicare with the addition of the Part D drug benefit. One year later, the Centers for Medicare & Medicaid Services estimated that about 27% of Veterans (3.8 million) who were both Medicare beneficiaries and enrolled in VA healthcare also were enrolled in Part D. The availability of Part D and other non-VA medication coverage may increase Veterans' options for obtaining medications; however, Part D coverage also might increase the complexity of Veterans' medication management when patients are treated by multiple VA and non-VA prescribers with limited sharing of information. As defined by the Joint Commission, medication reconciliation "is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions." Investigators in this study conducted a survey of Veterans who received care at one Midwestern VAMC and were eligible for Part D from 1/09 – 12/09, in order to ascertain their sources of coverage for medications, their medication acquisition from VA and non-VA pharmacies, and their communication with VA physicians about non-VA pharmacy use. The survey was mailed to a random sample of 800 Veterans, with responses received from 79 female and 384 male Veterans. VA administrative data were used to supplement information on patient demographics, as well as to obtain data on patients' inpatient and outpatient VA service use during 2009.
- Medicare-eligible Veterans often take multiple medications and use non-VA services and pharmacies. More than half of Veterans who used non-VA pharmacies reported having infrequent or no discussions with their VA physicians about their non-VA medications (54%), non-VA medication coverage (62%), and non-VA providers (56%).
- Of the Veterans in this study with a chronic condition, 93% reported taking more than one prescription regularly, and 30% of these individuals reported using medications for that condition that were prescribed by both VA and non-VA providers.
- More than half of the Veterans in this study (54%) reported having non-VA medication coverage, with 21% having Medicare Part D.
- The survey was limited to Veterans receiving care at one Midwestern VAMC.
- Data on non-VA medication use were self-reported by respondents, and non-VA pharmacy records were not available to confirm those prescriptions.
- The survey focused on physician-patient communication, thus respondents did not report on discussions with other healthcare team members. (e.g., pharmacists, nurses).
This study was funded by HSR&D (PPO 09-396). VA's Pharmacy Benefit Management/Strategic Healthcare Group was a clinical advisor on the project. Drs. Piette and Weaver also were supported by HSR&D Senior Research Career Scientist Awards. Drs. Stroupe, Smith, Weiner, and Weaver are part of HSR&D's Center for Management of Complex Chronic Care, Hines, IL.
Stroupe K, Smith B, Hogan T, St. Andre J, Gellad W, Weiner S, Lee T, Burk M, Cunningham F, Piette J, Rogers T, Huo Z, and Weaver F. Medication Acquisition across Systems of Care and Patient-Provider Communication among Older Veterans. American Journal of Health System Pharmacy May 2013;70(9):804-813.