自2013年以来,退伍军人事务(VA)医疗保健系统中的BZD处方有所减少。尚不清楚VA分配的BZD的下降是否已被MedicareD部分处方所抵消。
检查(1)是否,会计D部分,向老年退伍军人开具BZD处方的下降仍然存在;(2)与获得VA以外的BZD相关的患者特征和BZD来源的设施差异(仅限VA,VA和D部分,仅限D部分)。
采用混合效应多项逻辑模型的回顾性队列研究,检查与BZD来源相关的特征。
共有1,746,278名年龄≥65岁的退伍军人参加了VA和D部分,2013-2017。
BZD处方患病率和来源。
从2013年1月到2017年6月,通过VA使用D部分填写BZD处方的老年退伍军人的季度患病率从5.2下降到3.1%(p<0.001)或,会计D部分,从10.0到7.7%(p<0.001)。在2016年7月至2017年6月规定的BZD中,37.0%,10.2%,52.8%的人只接受退伍军人管理局的处方,VA和D部分,或仅D部分,分别。年龄较大与通过D部分获得BZD的几率更高(例如,与65-74相比,≥85的退伍军人在D部分与VA仅为1.8[95%最高后密度间隔(HPDI),1.69、1.86])。有物质使用障碍的退伍军人从任何来源都很少有BZD处方,但通过D部分与更高的处方几率相关(例如,D部分酒精使用障碍AOR与仅VA:1.9[95%HPDI,1.63,2.11])conclusions:ThedeclineinBZDusebyolderVeteranswithPartDcoverageremainedafteraccountingforPartD,但大多数BZD处方来自医疗保险。进一步减少BZD处方给老年退伍军人应该考虑从社区来源的处方。
There has been a reduction in BZD prescribing in the Veterans Affairs (VA) health care system since 2013. It is unknown whether the decline in VA-dispensed BZDs has been offset by Medicare Part D prescriptions.
To examine (1) whether, accounting for Part D, declines in BZD prescribing to older Veterans remain; (2) patient characteristics associated with obtaining BZDs outside VA and facility variation in BZD source (VA only, VA and Part D, Part D only).
Retrospective cohort
study with mixed effects multinomial logistic model examining characteristics associated with BZD source.
A total of 1,746,278 Veterans aged ≥65 enrolled in VA and Part D, 2013-2017.
BZD prescription prevalence and source.
From January 2013 to June 2017, the quarterly prevalence of older Veterans with Part D filling BZD prescriptions through the VA declined from 5.2 to 3.1% (p<0.001) or, accounting for Part D, from 10.0 to 7.7% (p<0.001). Among those prescribed BZDs between July 2016 and June 2017, 37.0%, 10.2%, and 52.8% received prescriptions from VA only, both VA and Part D, or Part D only, respectively. Older age was associated with higher odds of obtaining BZDs through Part D (e.g., compared to those 65-74, Veterans ≥85 had adjusted odds ratio [AOR] for Part D vs. VA only of 1.8 [95% highest posterior density interval (HPDI), 1.69, 1.86]). Veterans with substance use disorders accounted for few BZD prescriptions from any source but were associated with higher odds of prescriptions through Part D (e.g., alcohol use disorder AOR for Part D vs. VA alone: 1.9 [95% HPDI, 1.63, 2.11]) CONCLUSIONS: The decline in BZD use by older Veterans with Part D coverage remained after accounting for Part D, but the majority of BZD prescriptions came from Medicare. Further reducing BZD prescribing to older Veterans should consider prescriptions from community sources.