Medication Continuity Problematic for Patients Leaving DoD 

By Sandra Basu

WASHINGTON — The DoD’s lack of a formal policy for transitioning medication management means some servicemembers fall through the cracks when moving to the VA, especially when they are prescribed pain or psychiatric drugs, according to a recent Government Accountability Office (GAO) report.

“The Department of Defense's (DoD) and VA's efforts may not help all servicemembers manage their medication needs during transitions of care,” according to the report, “Medication Needs during Transitions May Not Be Managed for All Servicemembers.”

“DoD does not have a formal policy for transitioning medication needs for all servicemembers, and the efforts available to all servicemembers are limited,” the report said.

“The transition out of the DoD healthcare system, which can start when servicemembers discharge from the military and continue until they are cared for by receiving healthcare providers, such as VA, is a vulnerable point in terms of providing seamless care,” according to the report. “Transitions between healthcare systems may increase the likelihood of patients deviating from their treatment plans.”

On the other hand, the report noted, “identifying best practices and implementing them across the departments could better ensure overall continuity of care, including medication management, for servicemembers transitioning between healthcare providers, and could reduce their potential for adverse health effects from misusing or discontinuing psychiatric or pain medications.”

 Psychiatric and Pain Medications

That report pointed out that about 94,000 troops, including those discharged from the military, as well as reservists and guard members demobilized in fiscal years 2009 through 2011, had a psychiatric or pain medication. Almost half of these servicemembers subsequently received care from VA within nine months.

The most common psychiatric medications for discharged or demobilized troops from fiscal years 2009 through 2011 included antidepressants, while the most common pain medications included nonsteroidal anti-inflammatories, such as prescription-strength ibuprofen and an opioid — oxycodone acetaminophen, according to the report.

DoD and VA have some programs and policies to help transitioning troops manage their medications, but they do not help all transitioning troops, the report explained. For example, DoD’s medical assessments, which consist of an interview by a medical professional prior to discharge, might not always assure continued medication management.

The GAO report noted that “DoD cannot ensure that certain best practices, such as developing a plan for how to obtain medications during the transition and providing current medication lists at the point of discharge, are included during these assessments.”

VA and DoD also provide additional assistance with medication needs and case management to transitioning troops with complex healthcare needs and mental health conditions, but this assistance is focused on these specific groups rather than all troops, the report pointed out.

Other efforts in the DoD and VA to help manage servicemembers’ medication needs are not available across the board.

“For example, some military treatment facilities provide medication lists to servicemembers prior to discharge, and some VA medical centers conduct outreach to military treatment facilities. However, these efforts are not part of formal department-wide policies and are implemented at the discretion of individual facilities,” the report stated, adding that, overall, DoD “does not have a formal policy for transitioning medication needs for all servicemembers, and the efforts available to all servicemembers are limited.”

In addition, “Without such a policy, DoD cannot ensure, for example, that the basic step of providing current medication lists at the point of discharge is implemented across all its military facilities, including for the approximately 50% of servicemembers discharged with psychiatric or pain medications who do not connect with VA providers in a timely manner, if at all. As such, the departments cannot be assured that servicemembers’ medication needs are sufficiently met during transitions.”

 Current Medication List

Given that DoD is likely to be the last provider of healthcare prior to discharge, the GAO said “the department has primary responsibility for preparing servicemembers for transitions of care.”

GAO recommended that DoD develop a transition policy for medications that would apply to all servicemembers and that the plan  include a requirement that all servicemembers be provided with a current medication list prior to transitioning out of the military and changing healthcare providers.

DoD and VA need to work together “to identify and apply best practices for managing servicemembers’ medication needs during transitions of care, including assessing the extent to which practices currently available within existing transition policies and programs that are targeted to specific servicemember and veteran groups can be made more widely available,” the report added.

Both agencies agreed with the recommendations. VA stated that its Veterans Health Administration has several efforts under way to address the medication needs of transitioning troops.

While DoD concurred with the recommendations, it pointed out that it provides medication information already through the Bi-directional Health Information Exchange (BHIE) system, where VA providers can access it. The agency also stated that troops might receive a copy of their medical records, which would include a list of current medications.

While this might be the case, GAO stated DoD does not provide all troops a copy of their medical records and that BHIE “is limited to shared patients, such as servicemembers who receive care from both DoD and VA prior to separating from the military.”

“We believe that it is important that all servicemembers transitioning out of the DoD health care system be provided with a medication list at discharge, which is important for helping to ensure medications are used appropriately and that there is continuity of care for servicemembers changing health care providers,” the GAO wrote.