National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (1)
- Alcohol Use (1)
- Ambulatory Care and Surgery (1)
- Antimicrobial Stewardship (1)
- Asthma (1)
- Back Health and Pain (2)
- Behavioral Health (1)
- Blood Pressure (1)
- Blood Thinners (1)
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- Care Management (3)
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- Disparities (1)
- Elderly (2)
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- Health Literacy (1)
- Heart Disease and Health (2)
- Hepatitis (1)
- Kidney Disease and Health (1)
- Medicaid (3)
- Medicare (2)
- (-) Medication (29)
- Medication: Safety (1)
- Opioids (4)
- Outcomes (3)
- Pain (5)
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- Patient-Centered Outcomes Research (7)
- Patient Adherence/Compliance (11)
- Patient Safety (2)
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- Provider: Pharmacist (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 29 Research Studies DisplayedMilitello LG, Anders S, Downs SM
Understanding how primary care clinicians make sense of chronic pain.
This research explored how primary care clinicians manage their patients with chronic noncancer pain. They conducted Critical Decision Method interviews with 10 clinicians about 30 individual patients. Findings suggested that clinicians should focus on supporting sensemaking in the content of clinical evidence rather than trying to provide them with rules.
AHRQ-funded; HS023306.
Citation: Militello LG, Anders S, Downs SM .
Understanding how primary care clinicians make sense of chronic pain.
Cogn Technol Work 2018 Nov;20(4):575-84. doi: 10.1007/s10111-018-0491-1..
Keywords: Pain, Chronic Conditions, Opioids, Medication, Decision Making, Primary Care, Care Management
Weitzman ER, Magane KM, Wisk LE
Alcohol use and alcohol-interactive medications among medically vulnerable youth.
Information about the prevalence of alcohol use among youth with chronic medical conditions (YCMCs) who take alcohol-interactive (AI) medications is scant. This study attempts to address gaps and inform interventions by quantifying simultaneous exposure to alcohol use and AI medications among YCMCs. Participants were adolescents with a variety of chronic conditions: type 1 diabetes, juvenile idiopathic arthritis, moderate persistent asthma, cystic fibrosis, attention-deficit/hyperactivity disorder, inflammatory bowel disease. Participants completed an electronic survey designed to measure prevalence of exposure to AI medications and associations with alcohol usage in the past year. Many of the participants reported alcohol use, but drinking was less likely among those who took AI medications. The authors conclude that perceptions about alcohol-medication interference mediated the association between drinking and AI medication exposure.
AHRQ-funded; HS022986.
Citation: Weitzman ER, Magane KM, Wisk LE .
Alcohol use and alcohol-interactive medications among medically vulnerable youth.
Pediatrics 2018 Oct;142(4). doi: 10.1542/peds.2017-4026..
Keywords: Alcohol Use, Children/Adolescents, Chronic Conditions, Medication, Medication: Safety, Patient Safety, Vulnerable Populations
Mentias A, Shantha G, Chaudhury P
Assessment of outcomes of treatment with oral anticoagulants in patients with atrial fibrillation and multiple chronic conditions: a comparative effectiveness analysis.
The purpose of this retrospective comparative effectiveness analysis was to determine whether there are differences in efficacy and safety of dabigatran, rivaroxaban, and warfarin regarding stroke prevention and bleeding rates, respectively, in elderly patients with atrial fibrillation (AF) with multiple chronic conditions (MCC). The investigators concluded that oral anticoagulants were similarly effective in stroke prevention among patients with AF with MCC. However, the indicate that dabigatran and rivaroxaban use may be associated with lower rates of mortality in patients with MCC.
AHRQ-funded; HS023104.
Citation: Mentias A, Shantha G, Chaudhury P .
Assessment of outcomes of treatment with oral anticoagulants in patients with atrial fibrillation and multiple chronic conditions: a comparative effectiveness analysis.
JAMA Netw Open 2018 Sep 7;1(5):e182870. doi: 10.1001/jamanetworkopen.2018.2870..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research, Medication, Evidence-Based Practice, Comparative Effectiveness, Chronic Conditions
Shetterly Shetterly, S Flory, J
Diagnosis-based cohort augmentation using laboratory results data: the case of chronic kidney disease.
This study used data from FDA’s Sentinel System to determine if augmenting a diagnosis-based chronic kidney disease cohort with patients identified through laboratory results impacted cohort characteristics and outcomes. They divided the cohort into three different groups to compare demographic, clinical, and health care utilization characteristics. They observed mortality rates between the different groups.
AHRQ-funded; HS023898.
Citation: Shetterly Shetterly, S Flory, J .
Diagnosis-based cohort augmentation using laboratory results data: the case of chronic kidney disease.
Pharmacoepidemiol Drug Saf 2018 Aug;27(8):872-77. doi: 10.1002/pds.4583..
Keywords: Diagnostic Safety and Quality, Kidney Disease and Health, Chronic Conditions, Adverse Drug Events (ADE), Medication, Adverse Events
Turi KN, Gebretsadik T, Lee RL
Seasonal patterns of asthma medication fills among diverse populations of the United States.
Nonadherence to controller and overuse of reliever asthma medications are associated with exacerbations. In this study, the investigators aimed to determine patterns of seasonal asthma medication use and to identify time period(s) during which interventions to improve medication adherence could reduce asthma morbidity. The investigators concluded that a seasonal pattern of asthma medication fill rates likely represented a reactive response to a loss of disease control and increased symptoms.
AHRQ-funded; HS019669; HS022093.
Citation: Turi KN, Gebretsadik T, Lee RL .
Seasonal patterns of asthma medication fills among diverse populations of the United States.
J Asthma 2018 Jul;55(7):764-70. doi: 10.1080/02770903.2017.1362426..
Keywords: Asthma, Chronic Conditions, Medication, Patient Adherence/Compliance
Fredericksen RJ, Gibbons L, Brown S
Medication understanding among patients living with multiple chronic conditions: implications for patient-reported measures of adherence.
The purpose of this study was to assess knowledge of names and purposes of prescribed medications among patients with multiple chronic conditions. The investigators found that many patients demonstrated difficulty identifying the name and purpose of prescribed medications; this did not differ by demographic group or medication storage type. They suggest that patients may benefit from routine review of medications with their provider in order to improve health literacy, outcomes, and patient-reported adherence measurement.
AHRQ-funded; HS022242.
Citation: Fredericksen RJ, Gibbons L, Brown S .
Medication understanding among patients living with multiple chronic conditions: implications for patient-reported measures of adherence.
Res Social Adm Pharm 2018 Jun;14(6):540-44. doi: 10.1016/j.sapharm.2017.06.009..
Keywords: Chronic Conditions, Health Literacy, Medication, Patient Adherence/Compliance
Hansen RA, Hohmann N, Maciejewski ML
Continuity of medication management among adults with schizophrenia and comorbid cardiometabolic conditions.
This study examined whether medication adherence, inpatient admissions, and emergency department (ED) visits vary by the number and types of prescribers seen by adults with schizophrenia and cardiometabolic conditions. Greater antipsychotic adherence for adults receiving prescriptions from multiple psychiatric specialists was counteracted by lower statin adherence and greater risk of ED and inpatient utilization.
AHRQ-funded; HS023099.
Citation: Hansen RA, Hohmann N, Maciejewski ML .
Continuity of medication management among adults with schizophrenia and comorbid cardiometabolic conditions.
J Pharm Health Serv Res 2018 Mar;9(1):13-20. doi: 10.1111/jphs.12201.
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Keywords: Chronic Conditions, Medication, Behavioral Health, Patient Adherence/Compliance, Patient-Centered Healthcare
Klinge M, Coppler T, Liebschutz JM
The assessment and management of pain in cirrhosis.
The treatment of pain in patients with cirrhosis is complicated by unpredictable hepatic drug metabolism and a higher risk of adverse drug reactions. The researchers aimed to conduct a scoping review regarding pain management in cirrhosis. As with other populations, a multi-dimensional treatment approach to pain with a focus on physical, behavioral, procedural and pharmacologic treatment is recommended when caring for patients with cirrhosis and pain.
AHRQ-funded; HS022989.
Citation: Klinge M, Coppler T, Liebschutz JM .
The assessment and management of pain in cirrhosis.
Curr Hepatol Rep 2018 Mar;17(1):42-51. doi: 10.1007/s11901-018-0389-7.
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Keywords: Adverse Drug Events (ADE), Care Management, Chronic Conditions, Evidence-Based Practice, Medication, Pain, Patient-Centered Outcomes Research
Maciejewski ML, Hammill BG, Voils CI
Prescriber continuity and medication availability in older adults with cardiometabolic conditions.
Researchers examined whether the number of prescribers of essential medications was associated with the availability of medications, a surrogate for adherence, to manage diabetes, hypertension or dyslipidemia. They found that the number of prescribers was not significantly associated with availability of oral diabetes agents but having more prescribers is associated with increased medication availability in older Medicare beneficiaries with dyslipidemia or hypertension.
AHRQ-funded; HS023085.
Citation: Maciejewski ML, Hammill BG, Voils CI .
Prescriber continuity and medication availability in older adults with cardiometabolic conditions.
SAGE Open Med 2018 Feb 6;6:2050312118757388. doi: 10.1177/2050312118757388.
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Keywords: Chronic Conditions, Elderly, Medicare, Medication, Patient Adherence/Compliance
Shen C, Zhao B, Liu L
Adherence to tyrosine kinase inhibitors among Medicare Part D beneficiaries with chronic myeloid leukemia.
The authors of this study identified 836 patients with chronic myeloid leukemia (CML) with Medicare Part D insurance coverage who were new tyrosine kinase inhibitors (TKI) users and examined treatment nonadherence. They indicted that the current population-based study found a significantly higher rate of nonadherence among heavily subsidized patients with substantially lower out-of-pocket costs, which suggested that future research is needed to help lower the nonadherence rate among these individuals.
AHRQ-funded; HS020263.
Citation: Shen C, Zhao B, Liu L .
Adherence to tyrosine kinase inhibitors among Medicare Part D beneficiaries with chronic myeloid leukemia.
Cancer 2018 Jan 15;124(2):364-73. doi: 10.1002/cncr.31050.
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Keywords: Chronic Conditions, Medication, Medicare, Patient Adherence/Compliance
McCoy RG, Van Houten HK, Ross JS
HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study.
The researchers sought to determine the extent and effect of excessive testing for glycated hemoglobin (HbA1c) among adults with controlled type 2 diabetes. They found that in a US cohort of adults with stable and controlled type 2 diabetes, more than 60% received too many HbA1c tests, a practice associated with potential overtreatment with hypoglycemic drugs.
AHRQ-funded; HS018339.
Citation: McCoy RG, Van Houten HK, Ross JS .
HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study.
BMJ 2015 Dec 8;351:h6138. doi: 10.1136/bmj.h6138..
Keywords: Chronic Conditions, Diabetes, Healthcare Utilization, Medication, Patient-Centered Outcomes Research
Lo Re V, 3rd, Haynes K, Forde KA
Risk of acute liver failure in patients with drug-induced liver injury: evaluation of Hy's Law and a new prognostic model.
The researchers aimed to develop a highly sensitive model to identify drug-induced liver injury (DILI) patients at increased risk of acute liver failure (ALF). negative predictive value (0.99), but low level of sensitivity (0.68) and positive predictive value (0.02). Their model, comprising data on platelet count and total bilirubin level, identified patients with ALF with a C statistic of 0.87 and enabled calculation of a risk score (Drug-Induced Liver Toxicity ALF Score).
AHRQ-funded; HS018372.
Citation: Lo Re V, 3rd, Haynes K, Forde KA .
Risk of acute liver failure in patients with drug-induced liver injury: evaluation of Hy's Law and a new prognostic model.
Clin Gastroenterol Hepatol 2015 Dec;13(13):2360-8. doi: 10.1016/j.cgh.2015.06.020.
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Keywords: Antimicrobial Stewardship, Medication, Chronic Conditions, Adverse Drug Events (ADE), Clinical Decision Support (CDS)
Turner JA, Comstock BA, Standaert CJ
Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms?
The study’s aim was to identify patient characteristics associated with benefits from epidural injections of corticosteroid with lidocaine versus epidural injections of lidocaine only for lumbar spinal stenosis symptoms. It found that among 21 baseline patient characteristics examined, none, including clinician rated spinal stenosis severity, were consistent predictors of benefit from epidural injections of lidocain corticosteroid versus lidocaine only.
AHRQ-funded; HS019222; HS022972.
Citation: Turner JA, Comstock BA, Standaert CJ .
Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms?
Spine J 2015 Nov;15(11):2319-31. doi: 10.1016/j.spinee.2015.06.050..
Keywords: Patient-Centered Outcomes Research, Decision Making, Medication, Back Health and Pain, Chronic Conditions
Ajmera M, Sambamoorthi U, Metzger A
Multimorbidity and COPD Medication receipt among Medicaid beneficiaries with newly diagnosed COPD.
The aim of this study was to examine the association between multimorbidity and chronic obstructive pulmonary disease ( COPD) medication receipt among Medicaid beneficiaries with newly diagnosed COPD. It found that in this group 81.9 percen had at least one co-occurring chronic condition. After controlling for subject characteristics, adults with multimorbidity were less likely to receive COPD medications compared with those without any inflammation-related multimorbidity.
AHRQ-funded; HS022444.
Citation: Ajmera M, Sambamoorthi U, Metzger A .
Multimorbidity and COPD Medication receipt among Medicaid beneficiaries with newly diagnosed COPD.
Respir Care 2015 Nov;60(11):1592-602. doi: 10.4187/respcare.03788.
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Keywords: Chronic Conditions, Respiratory Conditions, Medication, Medicaid
LaFleur J, Hoop R, Korner E
Predictors of early discontinuation of pegylated interferon for reasons other than lack of efficacy in United States veterans with chronic hepatitis C.
The researchers determined whether selected patient characteristics predicted discontinued therapy for reasons other than lack of efficcacy (non-LOE) using national databases of U.S. veterans. They found that predictors of greatest magnitude included comorbidities of myocardial infarction/congestive heart failure, renal disease, platelets 100/mm or more, Black race, albumin 3.5 mg/dl or more, sleep aid use, and poor persistence with antidepressants and antihypertensive agents.
AHRQ-funded; HS018582.
Citation: LaFleur J, Hoop R, Korner E .
Predictors of early discontinuation of pegylated interferon for reasons other than lack of efficacy in United States veterans with chronic hepatitis C.
Gastroenterol Nurs 2015 Nov-Dec;38(6):417-28. doi: 10.1097/sga.0000000000000214.
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Keywords: Chronic Conditions, Hepatitis, Medication, Patient Adherence/Compliance
Chou R, Hashimoto R, Friedly J
Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis.
The researchers reviewed evidence on the benefits and harms of epidural corticosteroid injections in adults with radicular low back pain or spinal stenosis of any duration. They concluded that epidural corticosteroid injections for radiculopathy were associated with immediate reductions in pain and function. However, benefits were small and not sustained, and there was no effect on long-term surgery risk.
AHRQ-funded; 290201200014I.
Citation: Chou R, Hashimoto R, Friedly J .
Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis.
Ann Intern Med 2015 Sep 1;163(5):373-81. doi: 10.7326/m15-0934.
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Keywords: Medication, Back Health and Pain, Chronic Conditions, Comparative Effectiveness, Evidence-Based Practice
Shah ED, Siegel CA, Chong K
Patients with Crohn's disease are more likely to remain on biologics than immunomodulators: a meta-analysis of treatment durability.
The researchers aimed to clarify treatment durability by assessing subject discontinuations from clinical trials in the context of treatment efficacy. They found that for patients with Crohn’s disease, biologic therapies had higher durability than immunomodulators for induction and maintenance therapy.
AHRQ-funded; HS021747.
Citation: Shah ED, Siegel CA, Chong K .
Patients with Crohn's disease are more likely to remain on biologics than immunomodulators: a meta-analysis of treatment durability.
Dig Dis Sci 2015 Aug;60(8):2408-18. doi: 10.1007/s10620-015-3618-8..
Keywords: Patient Adherence/Compliance, Medication, Chronic Conditions, Comparative Effectiveness
Goldberg DS, Forde KA, Carbonari DM
Population-representative incidence of drug-induced acute liver failure based on an analysis of an integrated health care system.
The researchers conducted an assessment of the incidence and outcomes of acute drug-induced liver failure within a large, integrated healthcare system that approximates a population-representative cohort. They found the incident of acute drug-induced liver failure to be 1.61 per million person years with the overwhelming majority being due to over-the-counter medications or products.
AHRQ-funded; HS018372.
Citation: Goldberg DS, Forde KA, Carbonari DM .
Population-representative incidence of drug-induced acute liver failure based on an analysis of an integrated health care system.
Gastroenterology 2015 Jun;148(7):1353-61.e3. doi: 10.1053/j.gastro.2015.02.050..
Keywords: Medication, Chronic Conditions, Patient Safety
Ringwalt C, Roberts AW, Gugelmann H
Racial disparities across provider specialties in opioid prescriptions dispensed to Medicaid beneficiaries with chronic noncancer pain.
The purpose of this study was to examine differences across providers’ specialties in prescriptions filled by white and black Medicaid beneficiaries with chronic noncancer pain (CNCP). It found that race-based differences in beneficiaries’ dispensed opioid prescriptions were more prominent among patients of specialists in obstetrics and gynecology and internal medicine, as well as general practitioners/family medicine physicians.
AHRQ-funded; HS000032.
Citation: Ringwalt C, Roberts AW, Gugelmann H .
Racial disparities across provider specialties in opioid prescriptions dispensed to Medicaid beneficiaries with chronic noncancer pain.
Pain Med 2015 Apr;16(4):633-40. doi: 10.1111/pme.12555..
Keywords: Chronic Conditions, Disparities, Medicaid, Medication, Opioids, Pain, Racial and Ethnic Minorities
Hansen RA, Voils CI, Farley JF
Prescriber continuity and medication adherence for complex patients.
The purpose of this study was to examine the relationship between number of prescribers, number of conditions, and refill adherence to oral medications among 7,933 veterans who were identified with 1 to 4 cardiometabolic conditions: diabetes, hypertension, dyslipidemia, and/or heart failure. It found that for veterans taking antihypertensive or lipid-lowering medications, having more prescribers involved in care modestly decreased the likelihood of being adherent.
AHRQ-funded; HS019445.
Citation: Hansen RA, Voils CI, Farley JF .
Prescriber continuity and medication adherence for complex patients.
Ann Pharmacother 2015 Mar;49(3):293-302. doi: 10.1177/1060028014563266..
Keywords: Patient Adherence/Compliance, Medication, Chronic Conditions
Chou R, Turner JA, Devine EB
The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop.
This systematic review evaluated evidence on the effectiveness and harms of long-term (more than 3 months) opiod therapy for chronic pain in adults. It concluded that evidence is insufficient to determine the effectiveness of this therapy for improving chronic pain and function.
AHRQ-funded; 290201200014I
Citation: Chou R, Turner JA, Devine EB .
The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop.
Ann Intern Med. 2015 Feb 17;162(4):276-86. doi: 10.7326/M14-2559..
Keywords: Chronic Conditions, Comparative Effectiveness, Medication, Opioids, Outcomes, Pain, Patient-Centered Outcomes Research
Beadles CA, Farley JF, Ellis AR
Do medical homes increase medication adherence for persons with multiple chronic conditions?
The goal of this study was to assess the association between medical homes and adherence to newly initiated medications among Medicaid enrollees with multiple chronic conditions (MCC). The researchers examined data from North Carolina Medicaid enrollees with MCC and found that adherence to new medications is greater for those enrolled in medical homes.
AHRQ-funded; HS000032; HS019659.
Citation: Beadles CA, Farley JF, Ellis AR .
Do medical homes increase medication adherence for persons with multiple chronic conditions?
Med Care 2015 Feb;53(2):168-76. doi: 10.1097/mlr.0000000000000292..
Keywords: Chronic Conditions, Medication, Medicaid, Patient Adherence/Compliance, Patient-Centered Healthcare
Viswanathan M, Kahwati LC, Golin CE
Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis.
Medication therapy management (MTM) services (also called clinical pharmacy services) aim to reduce medication-related problems and their downstream outcomes. The purpose of this study was to assess the effect of MTM interventions among outpatients with chronic illnesses. The investigators graded the evidence as insufficient for most outcomes because of inconsistency and imprecision that stemmed in part from underlying heterogeneity in populations and interventions.
AHRQ-funded; 290201200008I.
Citation: Viswanathan M, Kahwati LC, Golin CE .
Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis.
JAMA Intern Med 2015 Jan;175(1):76-87. doi: 10.1001/jamainternmed.2014.5841..
Keywords: Medication, Ambulatory Care and Surgery, Chronic Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research, Provider: Pharmacist, Provider
McMullen CK, Safford MM, Bosworth HB
Patient-centered priorities for improving medication management and adherence.
The goal of the workshop was to identify and prioritize opportunities to advance PCMM by convening diverse stakeholders involved in prescribing and/or medication taking. A major conclusion was that engaging multiple stakeholders in setting a patient-centered research agenda and broadening the scope of adherence interventions to include other aspects of medication management resulted in priorities outside the traditional scope of adherence research.
AHRQ-funded; HS021093; HS021094; HS021107.
Citation: McMullen CK, Safford MM, Bosworth HB .
Patient-centered priorities for improving medication management and adherence.
Patient Educ Couns 2015 Jan;98(1):102-10. doi: 10.1016/j.pec.2014.09.015..
Keywords: Centers for Education and Research on Therapeutics (CERTs), Chronic Conditions, Medication, Patient Adherence/Compliance, Patient-Centered Healthcare
Voils CI, Sleath B, Maciejewski ML
Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.
The researchers sought to understand the reasons why patients have increasing numbers of prescribers of medications and to understand patient perspectives on advantages and disadvantages of having multiple prescribers, including effects on medication supply. They found that, with patients from a Veterans Affairs (VA) Medical Center, multiple prescribers arose through referrals and patients actively seeking non-VA prescribers to maximize timeliness and access to medications, to provide access to medications not on the VA formulary, and to minimize out-of-pocket costs.
AHRQ-funded; HS019445.
Citation: Voils CI, Sleath B, Maciejewski ML .
Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.
BMC Health Serv Res 2014 Oct 25;14:490. doi: 10.1186/s12913-014-0490-8.
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Keywords: Chronic Conditions, Medication, Diabetes, Blood Pressure, Heart Disease and Health