Impact of Dual Use of Department of Veterans Affairs and Medicare Part D Drug Benefits on Potentially Unsafe Opioid Use.

Autor: Gellad WF; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Thorpe JM; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Zhao X; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Thorpe CT; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Sileanu FE; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Cashy JP; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Hale JA; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Mor MK; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Radomski TR; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Hausmann LRM; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Donohue JM; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Gordon AJ; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Suda KJ; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Stroupe KT; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Hanlon JT; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Cunningham FE; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Good CB; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago., Fine MJ; Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago.
Jazyk: angličtina
Zdroj: American journal of public health [Am J Public Health] 2018 Feb; Vol. 108 (2), pp. 248-255. Date of Electronic Publication: 2017 Dec 21.
DOI: 10.2105/AJPH.2017.304174
Abstrakt: Objectives: To estimate the prevalence and consequences of receiving prescription opioids from both the Department of Veterans Affairs (VA) and Medicare Part D.
Methods: Among US veterans enrolled in both VA and Part D filling 1 or more opioid prescriptions in 2012 (n = 539 473), we calculated 3 opioid safety measures using morphine milligram equivalents (MME): (1) proportion receiving greater than 100 MME for 1 or more days, (2) mean days receiving greater than 100 MME, and (3) proportion receiving greater than 120 MME for 90 consecutive days. We compared these measures by opioid source.
Results: Overall, 135 643 (25.1%) veterans received opioids from VA only, 332 630 (61.7%) from Part D only, and 71 200 (13.2%) from both. The dual-use group was more likely than the VA-only group to receive greater than 100 MME for 1 or more days (34.3% vs 10.9%; adjusted risk ratio [ARR] = 3.0; 95% confidence interval [CI] = 2.9, 3.1), have more days with greater than 100 MME (42.5 vs 16.9 days; adjusted difference = 16.4 days; 95% CI = 15.7, 17.2), and to receive greater than 120 MME for 90 consecutive days (7.8% vs 3.1%; ARR = 2.2; 95% CI = 2.1, 2.3).
Conclusions: Among veterans dually enrolled in VA and Medicare Part D, dual use of opioids was associated with more than 2 to 3 times the risk of high-dose opioid exposure.
Databáze: MEDLINE
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