Regional differences in prescribing quality among elder veterans and the impact of rural residence

Brian C Lund; Mary E Charlton; Michael A Steinman; Peter J Kaboli

doi:10.1111/j.1748-0361.2012.00428.x

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Regional differences in prescribing quality among elder veterans and the impact of rural residence

Journal article

Peer reviewed

Regional differences in prescribing quality among elder veterans and the impact of rural residence

Brian C Lund, Mary E Charlton, Michael A Steinman and Peter J Kaboli

The Journal of rural health, Vol.29(2), pp.172-179

2013

DOI: 10.1111/j.1748-0361.2012.00428.x

PMCID: PMC3940354

PMID: 23551647

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Abstract

Medication safety is a critical concern for older adults. Regional variation in potentially inappropriate prescribing practices may reflect important differences in health care quality. Therefore, the objectives of this study were to characterize prescribing quality variation among older adults across geographic region, and to compare prescribing quality across rural versus urban residence. Cross-sectional study of 1,549,824 older adult veterans with regular Veterans Affairs (VA) primary care and medication use during fiscal year 2007. Prescribing quality was measured by 4 indicators of potentially inappropriate prescribing: Zhan criteria drugs to avoid, Fick criteria drugs to avoid, therapeutic duplication, and drug-drug interactions. Frequency differences across region and rural-urban residence were compared using adjusted odds-ratios. Significant regional variation was observed for all indicators. Zhan criteria frequencies ranged from 13.2% in the Northeast to 21.2% in the South. Nationally, rural veterans had a significantly increased risk for inappropriate prescribing according to all quality indicators. However, regional analyses revealed this effect was limited to the South and Northeast, whereas rural residence was neutral in the Midwest and protective in the West. Significant regional variation in prescribing quality was observed among older adult veterans, mirroring recent findings among Medicare beneficiaries. The association between rurality and prescribing quality is heterogeneous, and relying solely on national estimates may yield misleading conclusions. Although we documented important variations in prescribing quality, the underlying factors driving these trends remain unknown, and they are a vital area for future research affecting older adults in both VA and non-VA health systems.

United States Department of Veterans Affairs - standards

Cross-Sectional Studies

Rural Health Services - standards

United States

Humans

Rural Health Services - statistics & numerical data

Quality of Health Care - statistics & numerical data

Male

Prescription Drugs - administration & dosage

Practice Patterns, Physicians' - statistics & numerical data

Drug Utilization - standards

Residence Characteristics - statistics & numerical data

Aged, 80 and over

Female

Aged

Quality of Health Care - standards

United States Department of Veterans Affairs - statistics & numerical data

Drug Utilization - statistics & numerical data

Details

Title: Subtitle: Regional differences in prescribing quality among elder veterans and the impact of rural residence
Creators: Brian C Lund - Veterans Rural Health Resource Center-Central Region, VA Iowa City Health Care System, Iowa City, IA 52246, USA. Brian.Lund@va.gov
Mary E Charlton
Michael A Steinman
Peter J Kaboli
Resource Type: Journal article
Publication Details: The Journal of rural health, Vol.29(2), pp.172-179
DOI: 10.1111/j.1748-0361.2012.00428.x
PMID: 23551647
PMCID: PMC3940354
NLM abbreviation: J Rural Health
ISSN: 0890-765X
eISSN: 1748-0361
Publisher: England
Grant note: K23-AG030999 / NIA NIH HHS 5 U18 HSO16094 / PHS HHS K23 AG030999 / NIA NIH HHS
Language: English
Date published: 2013
Academic Unit: Health Management and Policy; Epidemiology; Internal Medicine
Record Identifier: 9983995057602771

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