Walid F. Gellad|Xinhua Zhao|Carolyn T. Thorpe|Maria K. Mor|Chester B. Good|Michael J. Fine
Dual Use of Department of Veterans Affairs and Medicare Benefits and Use of Test Strips in Veterans With Type 2 Diabetes Mellitus
VA Pittsburgh Healthcare System|University of Pittsburgh|VA Pittsburgh Healthcare System|VA Pittsburgh Healthcare System|University of Pittsburgh|VA Pittsburgh Healthcare System|University of Pittsburgh|VA Pittsburgh Healthcare System|University of Pittsburgh|VA Pittsburgh Healthcare System|University of Pittsburgh
selfmonitoring blood glucose costly component care diabetes mellitus unclear benefits patients taking insulin veterans dual department veterans affairs va medicare benefits access test strips systems raising potential overuseto examine patterns test strip receipt among older veterans diabetes determine whether receipt strips dual health care systems associated overusewe performed crosssectional retrospective cohort study using national va administrative data linked medicare parts b claims fiscal years 2008 2009 total 363996 communitydwelling veterans 65 years older diabetes used va health care system received test strips fiscal year 2009 included studyreceipt test strips va medicare va medicare covariates included sociodemographics comorbidity diabetes complications hemoglobin a1c levelquantity test strips dispensed overuse test strips defined 1 strip per day 365 strips per year among taking diabetes medications oral diabetes medications alone longacting insulin without shortacting insulin 4 strips per day 1460 strips per year among taking shortacting insulinoverall 260688 older veterans 716 diabetes received strips va 82826 228 medicare 20482 56 va medicare veterans receiving strips va medicare received strips median 600 interquartile range iqr 3501000 medicare median 400 iqr 200700 va median 200 iqr 100500 groups p 001 substantially greater odds overuse va group 554 vs 158 adjusted odds ratio 163 95 ci 146181 medications 553 vs 60 198 95 ci 189208 oral medications 874 vs 655 369 95 ci 330414 longacting insulin 328 vs 135 324 95 ci 305345 shortacting insulin patterns similar using conservative thresholds overuseveterans receive glucose test strips va medicare use strips likely potentially overuse strips results illustrate profound importance understanding dual va medicare coverage emblematic waste inefficiency