Table. Adjusted Use of PUM Among Older Veterans in 2015 by VA-Only vs Dual VA–Medicare Part D Usea.
| Medication Safety Measure | Dual VA–Part D Use (n = 52 839) | VA-Only Use (n = 227 101) | Differenceb |
|---|---|---|---|
| Any PUM | |||
| Exposure, % (95% CI) | 49.7 (49.2-50.0) | 34.9 (34.6-35.2) | +14.8 (14.3-15.3) |
| aOR (95% CI) | 1.84 (1.80-1.88) | 1 [Reference] | NA |
| Days exposed (95% CI)c | 72.7 (71.6-73.9) | 53.3 (52.5-54.1) | +19.4 (18.1-20.8) |
| PUM-HEDIS | |||
| Exposure, % (95% CI) | 19.3 (18.9-19.6) | 11.6 (11.4-11.8) | +7.7 (7.3-8.1) |
| aOR (95% CI) | 1.82 (1.77-1.88) | 1 [Reference] | NA |
| Days exposed (95% CI) | 20.2 (19.7-20.8) | 16.0 (15.6-16.4) | +4.2 (3.6-4.9) |
| PUM-ACB | |||
| Exposure, % (95% CI) | 38.6 (38.2-39.0) | 29.0 (28.7-29.3) | +9.6 (9.1-10.0) |
| aOR (95% CI) | 1.53 (1.50-1.57) | 1 [Reference] | NA |
| Days exposed (95% CI) | 49.6 (48.8-50.4) | 36.1 (35.5-36.7) | +13.5 (12.5-14.5) |
| PUM-DDI | |||
| Exposure, % (95% CI) | 4.4 (4.2-4.6) | 1.4 (1.3-1.5) | +3.0 (2.8-3.1) |
| aOR (95% CI) | 3.25 (3.02-3.48) | 1 [Reference] | NA |
| Days exposed (95% CI) | 2.9 (2.7-3.1) | 1.2 (1.1-1.3) | +1.7 (1.5-1.9) |
Abbreviations: ACB, anticholinergic cognitive burden; aOR, adjusted odds ratio; DDI, drug-drug interactions (drug combinations with high risk for severe interactions); HEDIS, Healthcare Effectiveness Data and Information Set for high-risk medication in the elderly; NA, not applicable; PUM, potentially unsafe medications; VA, Department of Veterans Affairs.
Includes 279 940 veterans. Covariates included age, sex, race/ethnicity, US region, county rurality, VA enrollment priority status, Elixhauser comorbidities, number of comorbidities, Veteran Integrated Service Network number, and low-income subsidy status. All covariates were entropy balanced to a standardized difference of P < .001.
All comparisons across Drug Benefit User Groups were statistically significant at the P < .001 level. Bias-corrected bootstrapping was used for assessing the number of days.
Indicates the sum of PUM-HEDIS, PUM-ACB, and PUM-DDI exposure days in 2015. A day when a patient was exposed to all 3 PUMs would count as 3 exposure days.