DIABETES PREVALENCE AND HOSPITAL AND PHARMACY USE IN THE VETERANS HEALTH ADMINISTRATION (1994) - USE OF AN AMBULATORY CARE PHARMACY-DERIVEDDATABASE

OBJECTIVE- To develop a diabetes registry from an outpatient pharmacy database to systematically analyze the prevalence of diabetes, pattern s of glycemic medication and glucose monitoring, pharmacy costs, and h ospital use related to diabetes care in the Veterans Health administra tion (VHA) in fiscal year (FY) 1994. RESEARCH DESIGN AND METHODS- Vete rans with diabetes were identified using a software program that extra cted the social security number (SSN) of patients receiving insulin, s ulfonylurea agents, or glucose-monitoring supplies. The cumulative FY9 4 cost for a drug was calculated by multiplying the units dispensed ti mes the unit cost for each fill, using the actual drug cost that was i n effect at the time of dispensing. Admission data were obtained by cr oss matching the SSN registry with the VHA Austin Mainframe Patient Tr eatment Files to retrieve associated diagnosis-related groups (DRG), P hysicians' Current Procedural Terminology (CPT), and International Cla ssification of Diseases, 9th revision, Clinical Modification (ICD-9-CM ) codes. RESULTS- From among 1,180,260 unique patients, 139.646 vetera ns with diabetes receiving insulin, oral agents, or glucose-monitoring strips were identified, accounting for a prevalence of 11.83% from 62 Veterans Administration medical centers. There were 63.078 individual s (52%) who received oral agents, of whom 26.3% also received blood gl ucose-monitoring supplies; 46.664 individuals (39%) received insulin, of whom 53.2% received blood glucose-monitoring supplies; and 9,440 in dividuals (8%) received both oral agents and insulin during FY94, with 64.4% receiving blood glucose-monitoring supplies. Only 1,482 (1.2%) individuals received monitoring supplies alone, and 129 patients (0.1% ) were provided with an insulin pump. Using an adjusted data set, 12% of veterans accounted for 24% of all outpatient pharmacy costs, with a n average expenditure of $622 for veterans with diabetes compared with $276 for veterans without diabetes. There was $454 (73%) for non-diab etes-specific prescriptions and $168 (27%) for prescriptions related t o glycemic control. Of pharmacy expenditures for glycemic control, $10 1 (60.1%)was attributed to insulin, oral agents, and supplies, while $ 67 (39.9%) was attributable to glucose monitoring. Veterans with diabe tes were admitted 1.6 times as frequently as veterans without diabetes . CONCLUSIONS- This study demonstrates the feasibility of using a phar macy-based electronic diabetes datal,asc in a paper system that can tr ack both claims and individual classes of medication based on a unique identifier number. While the prevalence of diabetes in the VHA is hig h relative to other health care systems and the general population, pa tterns of medication usage, pharmacy costs, and relative admission fre quency are comparable to results from the private sector.