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. 2011 Oct;59(10):1891-8.
doi: 10.1111/j.1532-5415.2011.03559.x. Epub 2011 Aug 30.

Trends in use of high-risk medications for older veterans: 2004 to 2006

Mary Jo V Pugh  1 , Joseph T Hanlon, Chen-Pin Wang, Todd Semla, Muriel Burk, Megan E Amuan, Ashlei Lowery, Chester B Good, Dan R Berlowitz
Affiliations

Trends in use of high-risk medications for older veterans: 2004 to 2006

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

Abstract

Objectives: To examine the change in use of high-risk medications for the elderly (HRME), as defined by the National Committee on Quality Assurance's Healthcare Effectiveness Data and Information Set (HEDIS) quality measure (HEDIS HRME), by older outpatient veterans over a 3-year period and to identify risk factors for HEDIS HRME exposure overall and for the most commonly used drug classes.

Design: Longitudinal retrospective database analysis.

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

Participants: Veterans aged 65 by October 1, 2003, and who received VA care at least once each year until September 30, 2006.

Measurements: Rates of use of HEDIS HRME overall and according to specific drug classes each year from fiscal year 2004 (FY04) to FY06.

Results: In a cohort of 1,567,467, high-risk medication exposure fell from 13.1% to 12.3% between FY04 and FY06 (P<.001). High-risk antihistamines (e.g., diphenhydramine), opioid analgesics (e.g., propoxyphene), skeletal muscle relaxants (e.g., cyclobenzaprine), psychotropics (e.g., long half-life benzodiazepines), endocrine (e.g., estrogen), and cardiac medications (e.g., short-acting nifedipine) had modest but statistically significant (P<.001) reductions (range -3.8% to -16.0%); nitrofurantoin demonstrated a statistically significant increase (+36.5%; P<.001). Overall HEDIS HRME exposure was more likely for men, Hispanics, those receiving more medications, those with psychiatric comorbidity, and those without prior geriatric care. Exposure was lower for individuals exempt from copayment. Similar associations were seen between ethnicity, polypharmacy, psychiatric comorbidity, access-to-care factors, and use of individual HEDIS HRME classes.

Conclusion: HEDIS HRME drug exposure decreased slightly in an integrated healthcare system. Risk factors for exposure were not consistent across drug groups. Future studies should examine whether interventions to further reduce HEDIS HRME use improve health outcomes.

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Figures

Figure 1
Figure 1
Exposure to High Risk Medications in the Elderly (HRME) by Drug Group
Figure 1
Figure 1
Trends in Use of High Risk Medication Classes in the Elderly: 2004-2006 Key
See this image and copyright information in PMC

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