Screening electronic veterans' health records for medication discontinuation

Objectives: Determine the viable yield of screening electronic Veterans Health Administration (VHA) records to identify patients who stop taking a long-term medication for reasons that might be addressed by healthcare providers. Study Design: Prospectively screened cohort with mailed follow-up of positive screens. Methods: Electronic healthcare records were screened to identify patients receiving care in a Veterans Administration (VA) Health Care System who became past due for resupply of medication (statin) prescribed to reduce cholesterol and risks of adverse cardiovascular events. Subsequently, administrative data were used to classify and characterize patients as true or false positive screens. A follow-up survey mailed to the first 1000 positive screens asked them if they were still taking a statin provided by the VHA, and if not, why? Results: From February to July 2010, 1000 (4.6%) of the statin-recipient cohort of 21,935 became past due for a resupply. Subsequently 824 (3.8%; 95% confidence interval [CI] 3.5%-4.0%) were classified as true positives (positive predictive value 82%; 95% CI 80%-85%), and 176 (0.8%; 95% CI 0.7%-0.9%) as false positives. However, the 824 true positives included 95 deceased, 17 long-term care residents, 302 who reported good reasons for no longer getting the statin, and 208 who eventually got another supply. The overall yield of good candidates for efforts to reinstate long-term use of statins was only 20%. Conclusions: The viable yield from electronically screening VA healthcare records to find patients who stopped taking statins was low. More complete records and sophisticated screening programs are needed to improve the yield.