• Carolyn T Thorpe, Walid F Gellad, Maria K Mor, John P Cashy, John R Pleis, Courtney H Van Houtven, Loren J Schleiden, Joseph T Hanlon, Joshua D Niznik, Ronald L Carico, Chester B Good, and Joshua M Thorpe.
• Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.
• Health Serv Res. 2018 Dec 1; 53 Suppl 3: 5375-5401.

ObjectiveTo evaluate the effect of dual use of VA/Medicare Part D drug benefits on antihypertensive medication supply in older Veterans with dementia.Data Sources/Study SettingNational, linked 2007-2010 Veterans Affairs (VA) and Medicare utilization and prescription records for 50,763 dementia patients with hypertension.Study DesignWe used inverse probability of treatment (IPT)-weighted multinomial logistic regression to examine the association of dual prescription use with undersupply and oversupply of antihypertensives.Data Collection/Extraction MethodsVeterans Affairs and Part D prescription records were used to classify patients as VA-only, Part D-only, or dual VA/Part D users of antihypertensives and summarize their antihypertensive medication supply in 2010: (1) appropriate supply of all prescribed antihypertensive classes, (2) undersupply of ≥1 class with no oversupply of another class, (3) oversupply of ≥1 class with no undersupply, or (4) both undersupply and oversupply.Principal FindingsDual prescription users were more likely than VA-only users to have undersupply only (aOR = 1.28; 95 percent CI = 1.18-1.39), oversupply only (aOR = 2.38; 95 percent CI = 2.15-2.64), and concurrent under- and oversupply (aOR = 2.89; 95 percent CI = 2.53-3.29), versus appropriate supply of all classes.ConclusionsObtaining antihypertensives through both VA and Part D was associated with increased antihypertensive under- and oversupply. Efforts to understand how best to coordinate dual-system prescription use are critically needed.© Health Research and Educational Trust.

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