title: Trends in use of high-risk medications for older veterans: 2004 to 2006.
abstract: OBJECTIVE
  To examine the change in use of high-risk medications for the elderly (HRME), 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 3-year period and to identify risk factors for HEDIS HRME exposure overall and for the most commonly used drug classes.
  
  
  METHODS
  Longitudinal retrospective database analysis.
  
  
  METHODS
  Outpatient clinics within the Department of Veterans Affairs (VA).
  
  
  METHODS
  Veterans aged 65 by October 1, 2003, and who received VA care at least once each year until September 30, 2006.
  
  
  METHODS
  Rates of use of HEDIS HRME overall and according to specific drug classes each year from fiscal year 2004 (FY04) to FY06.
  
  
  RESULTS
  In a cohort of 1,567,467, high-risk medication exposure fell from 13.1% to 12.3% between FY04 and FY06 (P<.001). 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<.001) reductions (range -3.8% to -16.0%); nitrofurantoin demonstrated a statistically significant increase (+36.5%; P<.001). Overall HEDIS HRME exposure was more likely for men, Hispanics, those receiving more medications, those with 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.
  
  
  CONCLUSIONS
  HEDIS HRME drug exposure decreased slightly in an integrated healthcare system. Risk factors for exposure were not consistent across drug groups. Future studies should examine whether interventions to further reduce HEDIS HRME use improve health outcomes.
authors: South Texas Veterans Health Care System, Veterans Evidence-Based Research and Implementation Center, San Antonio, Texas 78023, USA. maryjo.pugh2@va.gov
authors: Mary Jo V
authors: MJ
authors: Pugh
authors: Joseph T
authors: JT
authors: Hanlon
authors: Chen-Pin
authors: CP
authors: Wang
authors: Todd
authors: T
authors: Semla
authors: Muriel
authors: M
authors: Burk
authors: Megan E
authors: ME
authors: Amuan
authors: Ashlei
authors: A
authors: Lowery
authors: Chester B
authors: CB
authors: Good
authors: Dan R
authors: DR
authors: Berlowitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D015331:Cohort Studies; D004185:Disability Evaluation; D017723:Drug Utilization Review / Q000639:trends; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006297:Health Services Accessibility / Q000639:trends; D006302:Health Services Research / Q000639:trends; D006304:Health Status; D006801:Humans; D057970:Inappropriate Prescribing / Q000639:trends*; D008137:Longitudinal Studies; D008297:Male; D011785:Quality Assurance, Health Care / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000639:trends*; D012189:Retrospective Studies; D013781:Texas; D014728:Veterans / Q000706:statistics & numerical data*; D014768:Virginia