Medication Self-Management Among Veterans Eligible for Medicare Part D

Edward Hines Jr Va Hospital, Hines IL

Investigators

Abstract

Background/Rationale: Over 40% of veterans eligible for VA healthcare are enrolled in Medicare. Starting January 1, 2006, drug coverage was available to everyone in Medicare through Medicare Part D. Individuals with Medicare coverage, including veterans receiving care at VA, could enroll in Medicare Part D beginning November 15, 2005. Over 25% of VA users have enrolled in the Medicare Part D prescription drug benefit. Prescription medications are at the core of managing and treating chronic illnesses, and Part D may impact medication acquisition and adherence from VA and non-VA sources. To address these issues, we will conduct a nationwide survey of veterans about enrollment in Part D, factors affecting the enrollment decision, use of non-VA medications, and medication adherence. This pilot study will validate and refine the questionnaire that will be used in this national survey. Objectives: The objectives of this pilot study are to 1) review and edit the survey instrument, 2) conduct cognitive interviews with patients that assess whether the survey instrument is clearly understandable to respondents, 3) describe the response rate and respondent characteristics to facilitate determination of sample size and calculation of statistical power for national administration of the survey, 4) evaluate the internal consistency and validity of the survey, 5) describe item non-response rates and distribution of item response categories, and 6) refine and finalize the survey instrument. . Methods: We will refine and pilot test this questionnaire in collaboration with the University of Illinois at Chicago Survey Research Laboratory. We will edit the questionnaire and conduct an assessment of the revised questionnaire using cognitive interviewing techniques with <10 veterans at the Jesse Brown VA. We will then pilot this revised questionnaire using a sample of 800 Medicare-eligible veterans who 1) were at least 65 years of age (and thus Medicare eligible) as of January 2008 and who 2) received health care at the Hines VA Hospital in 2008. We will mail the survey to these 800 veterans. We will assess the response rate as the proportion who returned the survey. We will evaluate the consistency and validity of the survey by comparing the correlation of responses within the survey and by comparing the correlation of survey responses with data in national VA databases and in the Hines VISTA system. We will also examine the responses to determine the proportion of survey items with non-responses and to determine whether there is sufficient variability in the responses. Based on this validation process, we will refine and finalize the questionnaire.