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Evaluating the Use of Medicare Part D in the Veteran Population With Spinal Cord Injury/Disorder

Published:February 06, 2018DOI:https://doi.org/10.1016/j.apmr.2017.12.036

      Abstract

      Objective

      To examine the different sources of medications, the most common drug classes filled, and the characteristics associated with Medicare Part D pharmacy use in veterans with spinal cord injury/disorder (SCI/D).

      Design

      Retrospective, cross-sectional, observational study.

      Setting

      Outpatient clinics and pharmacies.

      Participants

      Veterans (N=13,442) with SCI/D using Medicare or Veteran Affairs pharmacy benefits.

      Interventions

      Not applicable.

      Main Outcome Measures

      Characteristics and top 10 most common drug classes were examined in veterans who (1) used VA pharmacies only; (2) used both VA and Medicare Part D pharmacies; or (3) used Part D pharmacies only. Chi-square tests and multinomial logistic regression analyses were used to determine associations between various patient variables and source of medications. Patient level frequencies were used to determine the most common drug classes.

      Results

      A total of 13,442 veterans with SCI/D were analyzed in this study: 11,788 (87.7%) used VA pharmacies only, 1281 (9.5%) used both VA and Part D pharmacies, and 373 (2.8%) used Part D pharmacies only. Veterans older than 50 years were more likely to use Part D pharmacies, whereas those with traumatic injury, or secondary conditions, were less associated with the use of Part D pharmacies. Opioids were the most frequently filled drug class across all groups. Other frequently used drug classes included skeletal muscle relaxants, gastric medications, antidepressants (other category), anticonvulsants, and antilipemics.

      Conclusions

      Approximately 12% of veterans with SCI/D are receiving medication outside the VA system. Polypharmacy in this population of veterans is relatively high, emphasizing the importance of health information exchange between systems for improved care for this medically complex population.

      Keywords

      List of abbreviations:

      Dual (Medicare Part D and VA pharmacy), HIE (health information exchange), Part D only (Medicare Part D pharmacy only), SCI/D (spinal cord injury/disorder), SCIDO (Spinal Cord Injury and Disorders Outcomes), UTI (urinary tract infection), VA (Department of Veterans Affairs), Veterans Affairs Only (Veterans Affairs pharmacy only)
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