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Appl Clin Inform 2017; 08(01): 235-249
DOI: 10.4338/ACI-2016-10-RA-0184
Research Article
Schattauer GmbH

Medication Use among Veterans across Health Care Systems

Khoa A. Nguyen
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
2   College of Pharmacy, Purdue University, West Lafayette, IN, USA
,
David A. Haggstrom
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
4   Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
5   Regenstrief Institute, Inc., Indianapolis, IN, USA
,
Susan Ofner
3   Department of Biostatistics, School of Medicine, Indiana University, IN, USA
,
Susan M. Perkins
3   Department of Biostatistics, School of Medicine, Indiana University, IN, USA
,
Dustin D. French
6   Department of Ophthalmology and the Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, and the Veterans Affairs Health Services Research and Development Service, in Chicago, IL, USA
,
Laura J. Myers
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
,
Marc Rosenman
8   Department of Pediatrics, Children’s Health Services Research, Indiana University, Regenstrief Institute, Inc.
,
Michael Weiner
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
5   Regenstrief Institute, Inc., Indianapolis, IN, USA
7   Indiana University Center for Health Services and Outcomes Research, Indianapolis, IN, USA
,
Brian E. Dixon
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
4   Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
5   Regenstrief Institute, Inc., Indianapolis, IN, USA
,
Alan J. Zillich
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
2   College of Pharmacy, Purdue University, West Lafayette, IN, USA
› Author Affiliations Funding This project was supported by the U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Service, grant number IIR 11-058, Evaluation of VLER Indiana Health Information Exchange Demonstration Project. This work was further supported by VA HSR&D grant CIN 13-416 at the Richard L Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana. Dr. Weiner is Chief of Health Services Research and Development at the Richard L Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana.
Further Information

Publication History

Received: 26 October 2016

Accepted: 06 January 2017

Publication Date:
20 December 2017 (online)

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Summary

Introduction: Dual healthcare system use can create gaps and fragments of information for patient care. The Department of Veteran Affairs is implementing a health information exchange (HIE) program called the Virtual Lifetime Electronic Record (VLER), which allows providers to access and share information across healthcare systems. HIE has the potential to improve the safety of medication use. However, data regarding the pattern of outpatient medication use across systems of care is largely unknown. Therefore, the objective of this study is to describe the prevalence of medication dispensing across VA and non-VA health care systems among a cohort Veteran population Methods: This study included all Veterans who had two outpatient visits or one inpatient visit at the Indianapolis VA during a 1-year period prior to VLER enrollment. Source of medication data was assessed at the subject level, and categorized as VA, INPC (non-VA), or both. The primary target was identification of sources for medication data. Then, we compared the mean number of prescriptions, as well as overall and pairwise differences in medication dispensing.

Results: Out of 52,444 Veterans, 17.4% of subjects had medication data available in a regional HIE. On average, 40 prescriptions per year were prescribed for Veterans who used both sources compared to 29 prescriptions per year from VA only and 25 prescriptions per year from INPC only sources. The annualized prescription rate of Veterans in the dual use group was 36% higher than those who had only VA data available and 61% higher than those who had only INPC data available.

Conclusions: Our data demonstrated that 17.4% of subjects had medication use identified from non-VA sources, including prescriptions for antibiotics, antineoplastics, and anticoagulants. These data support the need for HIE programs to improve coordination of information, with the potential to reduce adverse medication interactions and improve medication safety.

Keywords

Medication use - health information exchange - medication safety - dual health care systems
 

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