This article is more than 5 years old. Information may no longer be current.

Veterans with dementia who see multiple providers may be at increased risk

Potentially unsafe medication prescribing rates were lower among veterans with dementia who only received medical care within the Department of Veterans Affairs system compared with patients who also received care from providers outside the system, according to recent findings.

“Dual use of VA and non-VA health care on prescribing quality and safety has not previously been studied. However, prior research has shown such use to be associated with duplication and overuse of other health services and worse health outcomes,” Joshua M. Thorpe, PhD, MPH, from the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and colleagues wrote. “Use of both VA and non-VA prescribing may be particularly hazardous for veterans with dementia who have complex medication needs and impaired cognitive and functional abilities, and in turn may be more vulnerable to increased care fragmentation.”

The researchers investigated the impact of dual health care system use on potentially unsafe medication (PUM) prescribing for veteran outpatients with dementia. In this retrospective cohort study, investigators enrolled 75,829 veterans with dementia with continuous Medicare coverage from 2007 to 2010 (80% VA-only users; 20% VA-Medicare Part D [dual] users.)

To estimate the effect of dual-system use compared with VA-only prescribing, Thorpe and colleagues used four indicators of PUM prescribing. They evaluated any exposure to Healthcare Effectiveness Data and Information Set (HEDIS) high-risk medication in older adults (PUM-HEDIS), any daily exposure to prescriptions with a cumulative Anticholinergic Cognitive Burden (ACB) score of 3 or higher (PUM-ACB), any antipsychotic prescription (PUM-antipsychotic), and any PUM exposure (any-PUM).

They found dual users had more than double the odds exposure to any-PUM compared with VA-only users (OR = 2.2; 95% CI, 2.2-2.3), PUM-HEDIS (OR = 2.4; 95% CI, 2.2-2.8), and PUM-ACB (OR = 2.1; 95% CI, 2-2.2). The researchers also observed greater odds of PUM antipsychotic exposure in dual users (OR = 1.5; 95% CI, 1.4-1.6).

“Prescribing safety may be inadvertently compromised when national policies expand patient access to several poorly coordinated health care systems,” Thorpe and colleagues concluded. “Policymakers should consider implementing electronic health information exchanges and additional medication therapy management services across systems to keep pace with recent policies designed to expand veterans' access to non-VA providers and protect vulnerable patients from risks associated with dual-system use.” – by Savannah Demko

Disclosure: The researchers report grants from the U.S. Department of Veterans Affairs during the conduct of the study.