Study Finds VA Education Program Improves Quality of Care for Older Veterans

A new study shows the Veterans Affairs (VA) Geriatric Scholars Program improves the quality of care administered to older veterans in primary care settings.¹

Evaluators observed a reduction in the number of high-risk medications being prescribed by primary care providers after participating in the intensive geriatrics didactics course, which is a core component of the program that addresses major geriatric issues and effective management of these issues, including appropriate medication selection.

The VA Geriatric Scholars Program is a national workforce development initiative that trains VA primary care providers in geriatric medicine.² Now entering its twelfth year, the program has trained more than 1100 VA clinicians. All participants complete the intensive geriatrics didactics course. The medication recommendations and guidelines found within the curriculum are informed by the American Geriatrics Society (AGS) Beers Criteria®.³

These criteria specify potentially inappropriate medications (PIMs) to avoid prescribing to older adults or should be used with caution when combined with other prescriptions, among other recommendations, with the goal to reduce adverse drug events.

The study, published in The American Journal of Managed Care, included a national sample of 341 primary care providers who completed the Geriatric Scholars Program between September 1, 2008, and December 31, 2016. Evaluators measured participating providers’ monthly proportion of PIMs dispensed to older veterans (ie, over 65 years of age) 1-year prior to completing the intensive geriatrics didactics course and 1 year after completion.

An interrupted time series study design was used to control for pre-existing trends. Pharmacy dispensing data were extracted from the VA Corporate Data Warehouse. The analyses included more than 3 million pharmacy dispenings with more than 100,000 patients, increasing the strength of the study design and reliability of the findings.¹

Using segmented regression analysis, evaluators determined the change in trend (ie, slope) of PIM prescribing rates after participation in the intensive geriatrics didactics course. The results are intended to quantify the effect that the educational intervention had on providers’ prescribing behaviors.

Key findings

After adjusting for case mix, results showed participating providers dispensed 7971 fewer PIMs in the 12 months following the educational intervention compared with the 12 months prior, or an estimated reduction of 24 PIMs dispensed per provider. The maximum reduction occurred in the twelfth month after completing the intensive geriatrics didactics course, reflecting the authors’ suggestion that deprescribing is a multistep patient-provider process that occurs over time. Findings remained consistent between rural and urban primary care settings.

AGS spokesman Todd Semla, PharmD, former AGS president and co-chair of the AGS Beers Criteria® expert panel, offers the following observations:

The Department of Veterans Affairs has been a constant leader in advancing clinical geriatricsand aging research. Nearly 50% of Veterans receiving their care from the VA are age 65 and older, thus it is vital that the VA make investments to improve prescribing practices in an effort to reduce medication harms. The VA Geriatric Scholars Program is one example of a successful effort. By using expert tools like the AGS Beers Criteria® in its instruction, the VA Geriatric Scholars Program holds real promise for reducing the use of potentially inappropriate medications, as demonstrated by this data. That’s an encouraging sign for the care of older veterans—and all Americans—need as they age.

The views expressed in this article are those of the author and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. The VA Office of Rural Health funds the Geriatric Scholars Program and its evaluation.

Maureen Jerrett is a communications contractor for Veterans Affairs.

References

• Burningham, Z., et al. "VA Geriatric Scholars Program's impact on prescribing potentially inappropriate medications." Am J Manag Care. 2019;25(9):425-430.
• Kramer BJ, Creekmur B, Howe JL, et al. Veterans Affairs Geriatric Scholars Program: enhancing existing primary care clinician skills in caring for older Veterans. J Am Geriatr Soc. 2016;64(11):2343-2348. doi: 10.1111/jgs.14382.
• By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674—694. doi:10.1111/jgs.15767.