{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:19:07Z","timestamp":1787653147392,"version":"build-2736575974"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate whether eligibility for Veterans Health Administration (VA)\u2010purchased community care, which expanded Veterans' access to care outside VA, was associated with increased polypharmacy or potentially inappropriate medication use among older adult Veterans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>Regression discontinuity design, leveraging the distance threshold for community care eligibility (residing &gt;\u200940\u2009miles from the nearest VA facility with \u2265 1 or more full\u2010time primary care physician), to examine the effects of community care eligibility on polypharmacy and potentially inappropriate medication use among Veterans aged \u2265\u200965\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>VA pharmacy data for all prescriptions filled at VA facilities, VA Program Integrity Tool files for prescriptions paid by VA and filled in community pharmacies, and Medicare Part D data. Analyses included annual cross\u2010sectional samples of Veterans 36\u201339\u2009miles or 41\u201344\u2009miles from their nearest VA facility during FY 2016\u20132019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>The sample included 399,250 Veteran\u2010year observations, of which 226,157 (56.6%) were 36\u201339\u2009miles and 173,093 (43.4%) were 41\u201344\u2009miles from the nearest eligible VA facility. Overall, we observed no discontinuities across the 40\u2010mile threshold in the number of unique medications filled annually (\u22120.06 medications; 95% confidence interval [CI], \u22120.15 to 0.03). There were no discontinuities in proportions of Veterans filling \u2265\u20095 unique medications (\u22120.25 percentage points [pp]; 95% CI, \u22120.84 to 0.34), \u2265\u200910 medications (\u22120.55\u2009pp.; 95% CI, \u22121.24 to 0.14), \u2265\u20091 medication on the Beers list (\u22120.02\u2009pp.; 95% CI, \u22120.63 to 0.59), or \u2265\u20091 high\u2010risk drug\u2013drug interaction (\u22120.05\u2009pp.; 95% CI, \u22120.17 to 0.07). Among Veterans with mental health conditions, exceeding the 40\u2010mile threshold was associated with a higher likelihood of filling \u2265\u200910 unique medications annually (2.06\u2009pp.; 95% CI, 0.42 to 3.70). We did not observe clinically or statistically significant discontinuities in other subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, eligibility for VA\u2010purchased community care was not associated with increased polypharmacy or potentially inappropriate medication use among older adult Veterans.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70152","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:57:43Z","timestamp":1785740263000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of\n                    <scp>VA<\/scp>\n                    \u2010Purchased Community Care on Polypharmacy and Potentially Inappropriate Medication Use in Older Adult Veterans"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0185-3256","authenticated-orcid":false,"given":"Catherine S.","family":"Hwang","sequence":"first","affiliation":[{"name":"Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System  Portland Oregon USA"},{"name":"Division of General Internal Medicine and Geriatrics Oregon Health and Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7439-0799","authenticated-orcid":false,"given":"Eric T.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion (CHERP), VA Philadelphia Health Care System  Philadelphia Pennsylvania USA"},{"name":"School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florentina E.","family":"Sileanu","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion (CHERP), VA Pittsburgh Health Care System  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaming","family":"Li","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion (CHERP), VA Pittsburgh Health Care System  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn T.","family":"Thorpe","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion (CHERP), VA Pittsburgh Health Care System  Pittsburgh Pennsylvania USA"},{"name":"Eshelman School of Pharmacy University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria K.","family":"Mor","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion (CHERP), VA Pittsburgh Health Care System  Pittsburgh Pennsylvania USA"},{"name":"Department of Biostatistics and Health Data Science, School of Public Health University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7279-188X","authenticated-orcid":false,"given":"Thomas R.","family":"Radomski","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion (CHERP), VA Pittsburgh Health Care System  Pittsburgh Pennsylvania USA"},{"name":"Division of General Internal Medicine University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Cashy","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion (CHERP), VA Pittsburgh Health Care System  Pittsburgh Pennsylvania 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