Patient Possession of Excess Medication Supply in the VA: A Retrospective Database Study.
Patient Possession of Excess Medication Supply in the VA: A Retrospective Database Study.
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退伍军人管理局患者拥有过量药物供应：一项回顾性数据库研究。
DOI：
10.1097/mlr.0000000000001211
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发表时间：
2019
期刊：
影响因子：
3
通讯作者：
Rosen,AmyK
中科院分区：
文献类型：
--
作者：
Linsky,Amy;Stolzmann,Kelly;Simon,StevenR;Cabral,Howard;Rosen,AmyK
背景：药物重叠导致药物过量是治疗重复的一种形式，本身就是一种潜在的不适当处方。目的：确定退伍军人健康管理局潜在药物过量的流行率，并确定相关的药物水平、患者水平和系统水平因素。研究设计：一项回顾性数据库研究。研究对象：所有在2014财年接受退伍军人健康管理局药房分发的≥1处方药的退伍军人。测量：每个患者的主要结果定义为所有重叠事件的药物过量天数(同时分配相同名称的药物。预测因素包括药物水平、患者水平和系统水平的因素。结果：在4,687,453名退伍军人中，有≥-1用药重叠事件。患者被处方的中位数为7[四分位数范围(IQR)，3-12]，有2(IQR，0-5)重叠发作的中位数，以及27(IQR，0-96)天的超量用药。在调整后的回归模型中，与更大的用药过量风险相关的因素包括有更多的合并症、多个处方医生、填写地点的组合(合并邮购药店与当地药店)和多个处方持续时间(≥90d与更短)。结论：VHA使用者的用药过量很高，近三分之二的患者经历了至少1次重复用药。随着邮购药房和90天供应等制度越来越多地被实施，以降低成本和改善服药依从性，重要的是认识到系统层面的潜在低效和潜在的不适当处方。
Background:Medication overlap leading to medication excess is a form of therapeutic duplication, itself a type of potentially inappropriate prescribing.Objective:To determine the prevalence of potential medication excess in the Veterans Health Administration (VHA) and identify associated medication-level, patient-level, and system-level factors.Research Design:A retrospective database study.Subjects:All veterans who received≥ 1 prescription dispensed by a VHA pharmacy in fiscal year 2014.Measures:The primary outcome of “medication excess” was defined for each patient as the number of excess days’ worth of medications for all overlap episodes (concurrently dispensed medications with the same name for> 10 d). Predictors included medication-level, patient-level, and system-level factors. Multivariable negative binomial regression analyses estimated the rate ratio of each predictor with medication excess.Results:Among 4,687,453 veterans, 64% had≥ 1 medication overlap episodes. Patients were prescribed a median of 7 [interquartile range (IQR), 3–12] unique medications, had a median of 2 (IQR, 0–5) overlap episodes, and a median of 27 (IQR, 0–96) days of medication excess. In adjusted regression models, factors associated with greater risk of medication excess included having more comorbidities, multiple prescribers, a combination of filling locations (consolidated mail-order pharmacy vs. local pharmacy), and multiple prescription durations (≥ 90 d vs. less).Conclusions:Medication excess was high among VHA users, with nearly two-thirds of patients experiencing at least 1 duplicative medication. As systems such as mail-order pharmacies and 90-day supply are increasingly implemented to reduce costs and improve medication adherence, it is important to recognize the potential for systems-level inefficiencies and potentially inappropriate prescribing.