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. 2011 Sep;59(9):1673-8.
doi: 10.1111/j.1532-5415.2011.03524.x. Epub 2011 Aug 10.

Exposure to potentially harmful drug-disease interactions in older community-dwelling veterans based on the Healthcare Effectiveness Data and Information Set quality measure: who is at risk?

Mary Jo V Pugh  1 , Catherine I Starner, Megan E Amuan, Dan R Berlowitz, Monica Horton, Zachary A Marcum, Joseph T Hanlon
Affiliations

Exposure to potentially harmful drug-disease interactions in older community-dwelling veterans based on the Healthcare Effectiveness Data and Information Set quality measure: who is at risk?

Mary Jo V Pugh et al. J Am Geriatr Soc. 2011 Sep.

Abstract

Objectives: To identify prevalence and risk factors for exposure to drug-disease interactions included in the Healthcare Effectiveness Data and Information Set (HEDIS) Drug-Disease Interaction (Rx-DIS) measure.

Design: Cross-sectional retrospective database analysis.

Setting: Outpatient clinics within the Department of Veterans Affairs (VA).

Participants: Individuals aged 65 and older who received VA outpatient care between October 1, 2003, and September 30, 2006.

Measurements: Rx-DIS exposure based on the HEDIS measure was identified in VA patients with dementia, falls, and chronic renal failure using VA pharmacy and administrative databases. Factors associated with Rx-DIS exposure were examined, including demographic, health status, and access-to-care factors, including VA outpatient health services use and copayment status.

Results: Of the 305,041 older veterans who met criteria for inclusion, the 1-year prevalence of Rx-DIS exposure was 15.2%; prevalence was 20.2% for dementia, 16.2% for falls, and 8.5% for chronic renal failure. Patients with high disease burden (physical, psychiatric, number of medications) were significantly more likely to have Rx-DIS exposure, regardless of condition. Hispanics and individuals with no copayments were more likely to have Rx-DIS exposure than whites or those with required copayments. There was variation in other predictors based on the type of Rx-DIS.

Conclusion: The prevalence of Rx-DIS was common in older VA outpatients. Future studies should examine the risk of Rx-DIS exposure on health outcomes using separate analyses for each type of Rx-DIS separately before combining all Rx-DIS into a single measure of exposure. Studies that examine the effectiveness of interventions to reduce Rx-DIS exposure will also be helpful in improving the quality of care for older adults.

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Conflict of interest statement

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Authors MJP and MH are employed by the South Texas Veterans Health Care System. DRB and MEA are employed by the Edith Nourse Rogers Memorial VA Hospital and JTH is employed by the VA Pittsburgh Healthcare System. This study was funded by VA HSR&D IIR 06-062.

Dr. Pugh has received research funding from VA HSR&D DHI 09-237 (PI); VA HSR&D IIR-06-062 PI, Epilepsy Foundation PI, VA HSRD PPO 09-295 PI, VA HSR&D IIR 02-274 PI. Pugh as co-I: VA HSR&D IIR 08-274, VA HSR&D SDR-07-042, IIR-05-121, IAF-06-080, IIR-09-335, SHP 08-140, TRX 01-091 Department of Defense CDMRP 09090014, NIH R01-NR010828, Pugh Speaker Honoraria: 2009 Kelsey Seybold Research Foundation $400.

Dr Berlowitz has received funding from VA HSR&D RRP 09-112 as PI, VA HSR&D IIR-06-062 as Co-I.

Dr. Hanlon has received research funding from National Institute of Aging grants (R01AG027017, P30AG024827, T32 AG021885, K07AG033174, R01AG034056), a National Institute of Mental Health grant (R34 MH082682), a National Institute of Nursing Research grant (R01NR010135), an Agency for Healthcare Research and Quality grant (R01HS017695) and from VA HSR&D IIR-06-062.

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