Helping Veterans Navigate Dual Pharmacy Benefits

帮助退伍军人享受双重药房福利

• 批准号: 10595612
• 负责人: Anna Hung
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10595612
• 关键词: Address; Adherence; Adverse event; Affect; Antidiabetic Drugs; Caregivers; Community Healthcare; Cost Sharing; Data; Data Analyses; Decision Aid; Decision Making; Development; Diabetes Mellitus; Disadvantaged; Eligibility Determination; Enrollment; Expenditure; Face; Formularies; Goals; Health Services Research; Healthcare; High Prevalence; Homogeneously Staining Region; Hybrids; Insurance Benefits; Intervention; Interview; Knowledge; Learning; Link; Medical Records; Medicare; Medicare claim; Methodology; Methods; Names; Non-Insulin-Dependent Diabetes Mellitus; Pharmaceutical Preparations; Policies; Provider; Qualitative Methods; Research; Research Methodology; Research Personnel; Research Training; Resources; Retrospective cohort study; Structure; Subgroup; Surveys; Testing; Time; Training; Travel; Veterans; Wait Time; acceptability and feasibility; aging population; care fragmentation; career; copayment; cost; data warehouse; disorder control; effectiveness/implementation trial; experience; experimental study; future implementation; glycemic control; health care availability; improved; innovation; medication compliance; medication nonadherence; pharmacy benefit; preference; satisfaction; skills; tool

Background: Nearly 30% of Veterans with diabetes dually use Medicare Part D and VA to fill their antidiabetic medications, and dual users have poorer glycemic control and poorer medication adherence than Veterans who fill only through VA. Yet few resources exist to help Veterans understand and navigate between these dual pharmacy benefits. Significance/Impact: The goal of this research is to understand how Veterans are choosing between VA and Part D, identify knowledge gaps, and rigorously develop and test an intervention that will educate and optimize Veteran choice on prescription coverage. Innovation: This research is innovative because it: i) uses a stated-preference research method, called a discrete choice experiment, to quantify Veteran preferences when choosing which pharmacy benefit through which to fill their antidiabetic medications and ii) rigorously develops the first Veteran-facing decision aid that helps improve Veteran decision-making about where to fill their medication. By applying a Veteran-centered intervention focused on access to care and health care value to an aging population with a costly and prevalent condition, this proposal aligns with strategic goals for HSR&D, PBM, and VA in general. Specific Aims: The specific aims of the CDA-2 proposal are: 1) Identify medication acquisition challenges and informational needs that Part D-enrolled Veterans have when filling antidiabetic medications through VA or Medicare Part D; 2) Estimate how Veteran preferences around aspects such as prescription coverage, travel time, wait time, medication copay, and chance of adverse events influence where Part D-enrolled Veterans choose to fill antidiabetic medications; 3) Develop and assess feasibility and acceptability of a decision aid that helps Part D-enrolled Veterans comprehend VA and Medicare Part D prescription benefits to optimize choice on where to fill medications; and 4) Evaluate how dual use of VA and Part D to fill antidiabetic medications affects medication expenditures for Veterans, Medicare, and VA. Methodology: The proposed research consists of four projects, all focused on Part D-enrolled Veterans using antidiabetic medications. Project 1 is a qualitative study to identify knowledge gaps and other medication acquisition barriers that Veterans experience when filling medications through Part D versus VA. Project 1 will comprise of 24 interviews with Part D- enrolled Veterans with type 2 diabetes, and 12 interviews with caregivers. Project 2 consists of a discrete choice experiment study that estimates how Veterans trade off between different aspects such as prescription coverage, travel time, wait time, medication copay, and chance of adverse events when they decide where to fill their medications. Project 3 will involve the development and assessment of feasibility and acceptability of a decision aid based on findings from Aims 1 and 2. Project 4 will encompass a retrospective cohort study, using VA Corporate Data Warehouse medical records linked to Medicare claims data, to study the impact of dual use of pharmacy benefit on costs to Veterans, Medicare, and VA. Implementation/Next Steps: Two IIRs will be submitted to support: i) an expanded secondary data analysis that informs future implementation of the decision aid and ii) a hybrid type I effectiveness-implementation trial assessing the impact of the decision aid on Veteran satisfaction; medication supply, switching, and adherence; glycemic control; and costs to the Veteran and VA.

背景：近30%的糖尿病退伍军人双重使用医疗保险D部分和VA来填补 他们的抗糖尿病药物，双重使用者的血糖控制较差， 药物依从性比退伍军人谁填补只通过VA。然而，几乎没有资源可以帮助 退伍军人了解并在这些双重药房福利之间导航。 意义/影响：本研究的目标是了解退伍军人如何选择 在VA和Part D之间，确定知识差距，并严格开发和测试 干预，将教育和优化退伍军人的选择处方覆盖面。 创新：这项研究是创新的，因为它：i）使用了国家偏好研究 方法，称为离散选择实验，以量化退伍军人的偏好时，选择 哪些药房受益，通过它来填充他们的抗糖尿病药物，以及ii）严格地 开发了第一个面向退伍军人的决策援助，有助于改善退伍军人的决策， 去哪里买药通过采用以退伍军人为中心的干预措施， 护理和保健价值的老龄化人口与昂贵的和普遍的条件，这 总体而言，提案与HSR&D、PBM和VA的战略目标一致。 具体目标：CDA-2提案的具体目标是：1）确定药物采购 D部分入组的退伍军人在填写抗糖尿病药物时面临的挑战和信息需求 药物通过VA或医疗保险部分D; 2）估计如何退伍军人的偏好周围 处方覆盖范围、旅行时间、等待时间、药物共付额和 不良事件影响D部分入组的退伍军人选择填写降糖药物的位置; 3)制定并评估有助于D部分入组的决策辅助工具的可行性和可接受性 退伍军人了解VA和Medicare Part D处方福利，以优化选择 在何处填充药物;和4）评价VA和D部分的双重使用如何填充抗糖尿病药物 药物影响退伍军人，医疗保险和VA的药物支出。 方法：拟议的研究包括四个项目，都集中在D部分-入学 使用抗糖尿病药物的退伍军人。项目1是一项定性研究， 差距和其他药物获取障碍，退伍军人的经验时，填补 D部分与VA部分的药物治疗。项目1将包括24次与D部分的访谈- 招募了2型糖尿病退伍军人，并与护理人员进行了12次访谈。项目2包括 一项离散选择实验研究，估计退伍军人如何在不同的 处方覆盖范围、旅行时间、等待时间、药物共付额和 当他们决定在哪里填充他们的药物时，会发生不良事件。项目3将涉及 根据调查结果制定和评估决策辅助工具的可行性和可接受性 目标1和2。项目4将包括一项回顾性队列研究，使用VA Corporate 数据仓库将医疗记录与医保理赔数据相关联，研究双重影响 对退伍军人、医疗保险和退伍军人事务部的费用使用药房福利。 实施/后续步骤：将提交两份独立投资报告，以支持： 数据分析，为决策辅助的未来实施提供信息，以及ii）混合I型 评估决策辅助对退伍军人影响的有效性实施试验 满意度;药物供应、转换和依从性;血糖控制;以及 退伍军人和退伍军人。

项目成果

Patient Risk-Benefit Preferences for Transcatheter Versus Surgical Mitral Valve Repair.

经导管与二尖瓣手术修复的患者风险效益偏好。

• DOI: 10.1161/jaha.123.032807
• 发表时间: 2024
• 期刊: Journal of the American Heart Association
• 影响因子: 5.4
• 作者: Hung,Anna;Yang,Jui-Chen;Wallace,Matthew;Zwischenberger,BrittanyA;Vemulapalli,Sreekanth;Mentz,RobertJ;Thoma,Elizabeth;Goates,Scott;Lewis,John;Strong,Susan;Reed,ShelbyD
• 通讯作者: Reed,ShelbyD