Pharmacy Data in the VA Health Care System

Smith, Mark W.; Joseph, George

doi:10.1177/1077558703256726

Cited by 81 publications

(76 citation statements)

References 23 publications

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“…We did not account for medications received outside the VHA system, though this effect would likely be small, as most VHA patients get their medications from the VHA system. 15,41 In addition, our measurement of primary care engagement was limited and may not completely describe the interaction between primary care engagement and BP control.…”

Section: Discussionmentioning

confidence: 99%

Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort

et al. 2016

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BACKGROUND: Incarceration is associated with increased risk of hypertension and cardiovascular disease mortality. We used data from the Veterans Aging Cohort Study (VACS) to explore the impact of incarceration on blood pressure (BP) control. METHODS: Among hypertensive VACS participants, we measured the association between self-reported recent incarceration or past (not recent) history of incarceration and BP control in the year following the survey. To analyze the association between incarceration and BP control, we u s e d l o g i s t i c r e g r e s s io n m od e l s a dj u s t e d f o r sociodemographic characteristics, clinical factors (HIV status and body mass index), and behavioral factors (history of smoking, unhealthy alcohol use, illicit drug use). We explored potential mediators including post-traumatic stress disorder (PTSD), depression, primary care engagement, and adherence to antihypertensive medications. RESULTS: Among the 3515 eligible VACS participants, 2304 participants met the inclusion criteria. Of these, 163 (7 %) reported recent incarceration, and 904 (39 %) reported a past history of incarceration. Participants with recent or past history of incarceration were more likely to have uncontrolled BP than those without a history of incarceration (67 % vs. 56 % vs. 51 %, p < 0.001). In multivariable analysis, recent incarceration (adjusted odds ratio [AOR] = 1.57 95 % confidence interval [CI]: 1.09-2.26), but not a past history of incarceration (AOR = 1.08 95 % CI: 0.90-1.30), was associated with uncontrolled BP compared with those who were never incarcerated. CONCLUSIONS: Among patients with a history of hypertension, recent incarceration is associated with having uncontrolled BP following release. Interventions are needed for recently released individuals to improve hypertension outcomes.

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Section: Discussionmentioning

confidence: 99%

Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort

et al. 2016

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“…42 Third, as our data were restricted to opioids obtained from a VHA pharmacy, we were unable to assess opioid analgesics received from outside sources. The VHA, however, offers generous pharmacy benefits 28 and almost all HIV-infected patients receive their antiretroviral agents through the VHA. 50 We did not assess provider types that prescribed the opioid medications.…”

Section: Discussionmentioning

confidence: 99%

“…Data for this cohort include information from the Clinical Case Registry, which is the VHA HIV registry, and the Decision Support System. 28,29 The study was approved by the Human Investigations Committee at Yale University and the VA Connecticut Healthcare System; it was granted a waiver for informed consent and is HIPAA compliant. Patients were excluded if they met any of the following criteria: 1) ambiguous HIV status; 2) cancer diagnosis, excluding non-epithelial skin cancers; 3) no inpatient or outpatient visit in FY2006, suggesting not currently receiving care from the VHA system; or 4) unclear opioid pharmacy data.…”

Section: Study Overviewmentioning

confidence: 99%

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

et al. 2012

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BACKGROUND: Opioids are increasingly prescribed, but there are limited data on opioid receipt by HIV status. OBJECTIVES: To describe patterns of opioid receipt by HIV status and the relationship between HIV status and receiving any, high-dose, and long-term opioids. DESIGN: Cross-sectional analysis of the Veterans Aging Cohort Study. PARTICIPANTS: HIV-infected (HIV+) patients receiving Veterans Health Administration care, and uninfected matched controls. MAIN MEASURES: Pain-related diagnoses were determined using ICD-9 codes. Any opioid receipt was defined as at least one opioid prescription; high-dose was defined as an average daily dose ≥120 mg of morphine equivalents; long-term opioids was defined as ≥90 consecutive days, allowing a 30 day refill gap. Multivariable models were used to assess the relationship between HIV infection and the three outcomes. KEY RESULTS: Among the HIV+ (n = 23,651) and uninfected (n=55,097) patients, 31 % of HIV+ and 28 % of uninfected (p<0.001) received opioids. Among patients receiving opioids, HIV+ patients were more likely to have an acute pain diagnosis (7 % vs. 4 %), but less likely to have a chronic pain diagnosis (53 % vs. 69 %). HIV+ patients received a higher mean daily morphine equivalent dose than uninfected patients (41 mg vs. 37 mg, p=0.001) and were more likely to receive high-dose opioids (6 % vs. 5 %, p<0.001). HIV+ patients received fewer days of opioids than uninfected patients (median 44 vs. 60, p<0.001), and were less likely to receive long-term opioids (31 % vs. 34 %, p< 0.001). In multivariable analysis, HIV+ status was associated with receipt of any opioids (AOR 1.40, 95 % CI 1.35, 1.46) and high-dose opioids (AOR 1.22, 95 % CI 1.07, 1.39), but not long-term opioids (AOR 0.94, 95 % CI 0.88, 1.01). CONCLUSIONS:Patients with HIV infection are more likely to be prescribed opioids than uninfected individuals, and there is a variable association with pain diagnoses. Efforts to standardize approaches to pain management may be warranted in this highly complex and vulnerable patient population.

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“…Three administrative VA databases were used in the analysis 31 : the Corporate Data Warehouse (CDW) 32 , the Decision Support System (DSS) National Pharmacy Extract 33 , and the Pharmacy Benefits Management (PBM) database 34 . In these 3 datasets, information is provided on individual dispensing episodes by VA pharmacies, including the date of dispensing, number of items dispensed, expected duration of the treatment prescribed, and the prescription instructions 34 .…”

Section: Methodsmentioning

confidence: 99%

Persistence and Dose Escalation of Tumor Necrosis Factor Inhibitors in US Veterans with Rheumatoid Arthritis

Cannon

DuVall²,

Haroldsen³

et al. 2014

J Rheumatol

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Objective.Limited evidence exists comparing the persistence, effectiveness, and costs of biologic therapies for rheumatoid arthritis in clinical practice. Comparative effectiveness studies are needed to understand real-world experience with these agents. We evaluated treatment patterns, costs, and effectiveness of tumor necrosis factor inhibitor (TNFi) agents in patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry.Methods.Observational data from the VARA registry and linked administrative databases were analyzed. Longitudinal data from VARA patients initiating adalimumab (ADA), etanercept (ETN), or infliximab (IFX) from 2003 (the date all agents were available within the Veteran Affairs) to 2010 were analyzed. Outcomes included Disease Activity Score using 28 joints (DAS28), treatment persistence, dose escalation, and direct costs of drugs and drug administration.Results.For 563 eligible patients, baseline DAS28, DAS28 improvements, and persistence on initial treatment were similar across agents. Fewer patients receiving ETN (n = 5/290; 2%) underwent dose escalation than did patients taking ADA (n = 32/204; 16%) or IFX (n = 44/69; 64%). Annual costs for first course of TNFi therapy were lower for injectable ADA ($13,100 US) and ETN ($13,500 US) than for intravenously administered IFX ($16,900 US).Conclusion.Despite similar persistence and clinical disease activity for these TNFi agents, rates of dose escalation were highest with ADA and IFX. Higher overall costs were noted for IFX without increases in effectiveness.

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Pharmacy Data in the VA Health Care System

Cited by 81 publications

References 23 publications

Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort

Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

Persistence and Dose Escalation of Tumor Necrosis Factor Inhibitors in US Veterans with Rheumatoid Arthritis

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