The Veterans Affairs Pharmacy System: Perfectly Designed to Achieve the Outcomes It Gets
Authors: David R. Gifford
Journal: Annals of Internal Medicine (2016)

Editorials7 February 2017The Veterans Affairs Pharmacy System: Perfectly Designed to Achieve the Outcomes It GetsDavid R. Gifford, MD, MPHDavid R. Gifford, MD, MPHFrom The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2590 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail On the surface, the study by Thorpe and colleagues (1) seems to be only about medication prescribing for dementia in the Veterans Affairs (VA) system, but it could serve as the basis for an entire medical school course on health policy. It has far-reaching implications for health care system design, medication prescribing, and daily clinical practice, particularly for the care of patients with chronic disease. The study highlights an overarching concept: “Every system is perfectly designed to achieve the outcomes it gets.”Health policy decisions in the United States give priority to consumer choice, especially as it relates to expanded ...References1. Thorpe JM, Thorpe CT, Gellad WF, Good CB, Hanlon JT, Mor MK, et al. Dual health care system use and high-risk prescribing in patients with dementia. A national cohort study. Ann Intern Med. 2017;166:157-63. doi:10.7326/M16-0551 LinkGoogle Scholar2. Lambrew JM. “Choice” in health care: what do people really want? New York: The Commonwealth Fund; 2005. Accessed at www.commonwealthfund.org/~/media/files/publications/issue-brief/2005/sep/choice–in-health-care–what-do-people-really-want/lambrew_853_choice_ib-pdf.pdf on 29 November 2016. Google Scholar3. Greene D. 49 states combat opioid epidemic with prescription database. Washington, DC: National Public Radio Morning Edition; 2016. 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Accessed at www.forbes.com/sites/zinamoukheiber/2014/04/22/how-surescripts-became-the-dominant-electronic-prescribing-network/#5d9736c8557f on 29 November 2016. Google Scholar7. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227-46. [PMID: 26446832] doi:10.1111/jgs.13702 CrossrefMedlineGoogle Scholar8. Levinson DR. Adverse events in hospitals: national incidence among Medicare beneficiaries. OEI-06-09-00090. Washington, DC: U.S. Department of Health and Human Services Office of Inspector General; 2010. Google Scholar9. Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med. 2003;163:1409-16. [PMID: 12824090] CrossrefMedlineGoogle Scholar10. Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005;330:765. [PMID: 15767266] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2590.Corresponding Author: David R. Gifford, MD, MPH, American Health Care Association, 1201 L Street Northwest, Washington, DC 20005; e-mail, [email protected]org.This article was published at Annals.org on 6 December 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDual Health Care System Use and High-Risk Prescribing in Patients With Dementia Joshua M. Thorpe , Carolyn T. Thorpe , Walid F. Gellad , Chester B. Good , Joseph T. Hanlon , Maria K. Mor , John R. Pleis , Loren J. Schleiden , and Courtney Harold Van Houtven Metrics Cited byPotentially unsafe medication prescribing in US veterans 7 February 2017Volume 166, Issue 3Page: 221-222KeywordsAdverse eventsClinical decision support systemsDementiaElectronic medical recordsHealth careHealth information technologyHospitalsInformation technologyOpioidsResearch laboratories ePublished: 6 December 2016 Issue Published: 7 February 2017 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...