Philip W Chui1,2, Lori A Bastian1,2, Eric DeRycke1, Cynthia A Brandt1,3, William C Becker1,2, Joseph L Goulet1. 1. Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT. 2. Department of Internal Medicine, Yale School of Medicine, New Haven, CT. 3. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
Abstract
OBJECTIVE: To examine the association of dual use of both Veterans Health Administration (VHA) and Medicare benefits with high-risk opioid prescriptions among Veterans aged 65 years and older with a musculoskeletal disorder diagnosis. DATA SOURCES/STUDY SETTING: Data were obtained from the VA Musculoskeletal Disorder (MSD) cohort and national Medicare claims data from 2008 to 2010. STUDY DESIGN: We conducted a retrospective analysis of Veterans enrolled in Medicare to examine the association of dual use with long-term opioid use (>90 days of prescription opioids/year) and overlapping opioid prescriptions. Multivariable logistic regression was performed adjusting for demographic and clinical characteristics. DATA COLLECTION/EXTRACTION METHODS: We identified 21,111 Veterans enrolled in Medicare who entered the MSD cohort in 2008 and received an opioid prescription in 2010. We linked VHA data with Medicare claims data to identify opioid prescriptions for these Veterans in 2010. PRINCIPAL FINDINGS: As compared to Veterans who used only VHA or Medicare, Veterans with dual use of VHA and Medicare were significantly more likely to be prescribed long-term opioid therapy (OR = 4.61 (95 percent CI 4.05-5.25) and were also found to have higher median number of opioid prescriptions and higher odds of overlapping opioid prescriptions in 1 year. Patients reporting moderate-to-severe pain, non-white-race/ethnicity, and higher scoring on the Charlson comorbidity index had significantly higher odds of long-term opioid prescriptions. CONCLUSIONS: Among Veterans aged 65 years or older, dual use of both VHA and Medicare was associated with higher odds of long-term opioid therapy. Our findings suggest there may be benefit to combining VHA and non-VHA electronic health record data to minimize exposure to high-risk opioid prescribing. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.
OBJECTIVE: To examine the association of dual use of both Veterans Health Administration (VHA) and Medicare benefits with high-risk opioid prescriptions among Veterans aged 65 years and older with a musculoskeletal disorder diagnosis. DATA SOURCES/STUDY SETTING: Data were obtained from the VA Musculoskeletal Disorder (MSD) cohort and national Medicare claims data from 2008 to 2010. STUDY DESIGN: We conducted a retrospective analysis of Veterans enrolled in Medicare to examine the association of dual use with long-term opioid use (>90 days of prescription opioids/year) and overlapping opioid prescriptions. Multivariable logistic regression was performed adjusting for demographic and clinical characteristics. DATA COLLECTION/EXTRACTION METHODS: We identified 21,111 Veterans enrolled in Medicare who entered the MSD cohort in 2008 and received an opioid prescription in 2010. We linked VHA data with Medicare claims data to identify opioid prescriptions for these Veterans in 2010. PRINCIPAL FINDINGS: As compared to Veterans who used only VHA or Medicare, Veterans with dual use of VHA and Medicare were significantly more likely to be prescribed long-term opioid therapy (OR = 4.61 (95 percent CI 4.05-5.25) and were also found to have higher median number of opioid prescriptions and higher odds of overlapping opioid prescriptions in 1 year. Patients reporting moderate-to-severe pain, non-white-race/ethnicity, and higher scoring on the Charlson comorbidity index had significantly higher odds of long-term opioid prescriptions. CONCLUSIONS: Among Veterans aged 65 years or older, dual use of both VHA and Medicare was associated with higher odds of long-term opioid therapy. Our findings suggest there may be benefit to combining VHA and non-VHA electronic health record data to minimize exposure to high-risk opioid prescribing. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.
Authors: Walid F Gellad; Joshua M Thorpe; Xinhua Zhao; Carolyn T Thorpe; Florentina E Sileanu; John P Cashy; Jennifer A Hale; Maria K Mor; Thomas R Radomski; Leslie R M Hausmann; Julie M Donohue; Adam J Gordon; Katie J Suda; Kevin T Stroupe; Joseph T Hanlon; Francesca E Cunningham; Chester B Good; Michael J Fine Journal: Am J Public Health Date: 2017-12-21 Impact factor: 9.308
Authors: Steven K Dobscha; Benjamin J Morasco; Anne E Kovas; Dawn M Peters; Kyle Hart; Bentson H McFarland Journal: Pain Med Date: 2014-12-28 Impact factor: 3.750
Authors: Joseph L Goulet; Robert D Kerns; Matthew Bair; William C Becker; Penny Brennan; Diana J Burgess; Constance M Carroll; Steven Dobscha; Mary A Driscoll; Brenda T Fenton; Liana Fraenkel; Sally G Haskell; Alicia A Heapy; Diana M Higgins; Rani A Hoff; Ula Hwang; Amy C Justice; John D Piette; Patsi Sinnott; Laura Wandner; Julie A Womack; Cynthia A Brandt Journal: Pain Date: 2016-08 Impact factor: 7.926
Authors: Sara E Heins; Christine Buttorff; Courtney Armstrong; Rosalie Liccardo Pacula Journal: Drug Alcohol Depend Date: 2021-09-22 Impact factor: 4.492
Authors: Taeko Minegishi; Melissa M Garrido; Michael Stein; Elizabeth M Oliva; Austin B Frakt Journal: J Gen Intern Med Date: 2020-11-03 Impact factor: 5.128
Authors: Audrey Béliveau; Anne-Marie Castilloux; Cara Tannenbaum; Philippe Vincent; Cristiano Soares de Moura; Sasha Bernatsky; Yola Moride Journal: CMAJ Open Date: 2021-02-09
Authors: Salva N Balbale; Lishan Cao; Itishree Trivedi; Jonah J Stulberg; Katie J Suda; Walid F Gellad; Charlesnika T Evans; Bruce L Lambert; Laurie A Keefer; Neil Jordan Journal: Mil Med Date: 2021-08-28 Impact factor: 1.563