VA-Purchased Community Care and Risk of Potentially Unsafe Concurrent Medication Use Among Veterans Receiving...

Area of Science:

• Health Services Research
• Pharmacology
• Public Health

Background:

• The Veterans Health Administration (VA) expanded community care access for eligible Veterans.
• Understanding medication co-prescribing patterns is crucial for patient safety.

Purpose of the Study:

• To determine if VA community care eligibility influenced the concurrent filling of opioid and central nervous system (CNS) medications.
• To identify potential increases in high-risk medication overlap.

Main Methods:

• A regression discontinuity design analyzed Veterans near the 40-mile threshold for community care eligibility.
• Local linear regression assessed the association between exceeding the threshold and overlapping opioid/CNS medication supplies (≥30 days).
• VA, Medicare, and Medicaid pharmacy data were utilized for prescription information from FYs 2016-2019.

Main Results:

• 34.1% of Veterans filling opioid prescriptions also received another CNS medication concurrently.
• Eligibility for community care was linked to a 1.14 percentage point increase in this medication overlap.
• Increased overlap was observed in Veterans with serious mental illness and among non-Hispanic Black Veterans in later study years.

Conclusions:

• VA community care eligibility showed a modest association with increased concurrent opioid and CNS medication use.
• Higher-risk co-prescribing was more evident in specific Veteran subgroups and during later study periods.
• Continued monitoring of medication overlap within VA community care is recommended.