Potentially inappropriate medication use in veterans residing in community living centers: have we gotten better?

Abstract

Objectives: To evaluate the use of medications classified as inappropriate according to the Health Plan Employer Data and Information Set (HEDIS) in elderly veterans residing in Department of Veterans Affairs (VA) nursing homes from 2004 to 2009 and to identify participant-specific correlates of use.

Design: Retrospective, cross-sectional study using VA administrative data merged with participant-specific data from the Minimum Data Set.

Setting: VA nursing homes (community living centers (CLCs)).

Participants: Veterans aged 65 and older residing in CLCs at the time of the prescribed medication use (N = 176,168).

Measurements: The number of exposed veterans aged 65 and older per facility receiving at least one HEDIS high-risk medication was determined.

Results: Between 2004 and 2009, 28,970 of 176,168 (mean 16.4 ± 9.5%) veterans received at least one HEDIS high-risk medication. Over the period, the number of veterans receiving high-risk medications decreased steadily from 23.9 ± 10.0% in 2004 to 10.0 ± 6.6% in 2009. Nevertheless, large facility variations remained in 2009, with rates from 0% to 44.4%. Certain characteristics were also associated with HEDIS high-risk medication use, including female sex (odds ratio (OR) = 1.6; 95% confidence interval (CI) = 1.25-2.04), cancer (OR = 1.19, 95% CI = 1.08-1.32), renal disease (OR = 1.16, 95% CI = 1.01-1.33), chronic obstructive pulmonary disease (OR = 1.16, 95% CI = 1.05-1.28), and diabetes mellitus (OR = 1.11, 95% CI = 1.02-1.22). Protective characteristics included age 75 and older (OR = 0.81, 95% CI = 0.73-0.90) and having a diagnosis of moderate (OR = 0.72, 95% CI = 0.64-0.82) or severe (OR = 0.72, 95% CI = 0.61-0.85) cognitive impairment.

Conclusion: The use of HEDIS medications among elderly veterans residing in VA nursing homes has markedly improved. Nevertheless, significant variations between facilities and certain subpopulations remain. A low percentage of women at VA CLCs make comparisons with community nursing homes difficult.

Keywords: HEDIS; Veterans Administration; inappropriate medications; nursing home.