OBJECTIVES
To examine the change in use of “High Risk Medications for the Elderly,” 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 three year time period. We also sought to identify risk factors for HEDIS HRME exposure overall, and among 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 by specific drug classes each year FY04-06.
RESULTS
In our cohort of 1,567,467, high risk medication exposure was reduced from 13.1% to 12.3% between FY04-06 (p<0.01). 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<0.01) reductions (range -3.8% to -16.0%); nitrofurantoin demonstrated a statistically significant increase (+36.5%; p<0.01). Overall HEDIS HRME exposure was more likely for men, Hispanics, those receiving more medications, 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 health care system. Risk factors for exposure were not consistent across drug groups.Future studies should examine whether interventions to further reduce HEDIS HRME use results in an improvement in health outcomes.