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Tytuł:
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Opioid Prescribing and Opioid Risk Mitigation Strategies in the Veterans Health Administration.
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Autorzy:
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Sandbrink F; Pain Management and Opioid Safety Program, Veterans Health Administration, Washington, DC, USA. .; Department of Neurology, Washington DC VA Medical Center, Washington, DC, USA. .; Uniformed Services University, Bethesda, MD, USA. .; George Washington University, Washington, DC, USA. .
Oliva EM; VA Program Evaluation and Resource Center, VA Office of Mental Health and Suicide Prevention, Menlo Park, CA, USA.; VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
McMullen TL; Pain Management and Opioid Safety Program, Veterans Health Administration, Washington, DC, USA.
Aylor AR; Pain Management and Opioid Safety Program, Veterans Health Administration, Washington, DC, USA.
Harvey MA; Patient Care Services, Pharmacy Benefits Management Service, Veterans Health Administration, Washington, DC, USA.
Christopher ML; Patient Care Services, Pharmacy Benefits Management Service, Veterans Health Administration, Washington, DC, USA.
Cunningham F; Patient Care Services, Pharmacy Benefits Management Service, Veterans Health Administration, Washington, DC, USA.
Minegishi T; Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA.; Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
Emmendorfer T; Patient Care Services, Pharmacy Benefits Management Service, Veterans Health Administration, Washington, DC, USA.
Perry JM; Pain Management and Opioid Safety Program, Veterans Health Administration, Washington, DC, USA.
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Źródło:
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Journal of general internal medicine [J Gen Intern Med] 2020 Dec; Vol. 35 (Suppl 3), pp. 927-934. Date of Electronic Publication: 2020 Nov 16.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: Secaucus, NJ : Springer
Original Publication: [Philadelphia, PA] : Hanley & Belfus, [c1986-
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MeSH Terms:
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Drug Overdose*/drug therapy
Drug Overdose*/epidemiology
Drug Overdose*/prevention & control
Veterans*
Analgesics, Opioid/adverse effects ; Humans ; Practice Patterns, Physicians' ; United States/epidemiology ; United States Department of Veterans Affairs ; Veterans Health
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References:
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Contributed Indexing:
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Keywords: VHA; academic detailing; opioid epidemic; opioids; pain management
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Substance Nomenclature:
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0 (Analgesics, Opioid)
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Entry Date(s):
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Date Created: 20201116 Date Completed: 20210514 Latest Revision: 20211203
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Update Code:
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20240105
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PubMed Central ID:
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PMC7728840
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DOI:
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10.1007/s11606-020-06258-3
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PMID:
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33196968
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Introduction: The Veterans Health Administration (VHA) has taken a multifaceted approach to addressing opioid safety and promoting system-wide opioid stewardship.
Aim: To provide a comprehensive evaluation of current opioid prescribing practices and implementation of risk mitigation strategies in VHA.
Setting: VHA is the largest integrated health care system in the United States.
Program Description: VHA prescribing data in conjunction with implementation of opioid risk mitigation strategies are routinely tracked and reviewed by VHA's Pharmacy Benefits Management Services (including Academic Detailing Service) and the Pain Management Program Office. Additional data are derived from the Partnered Evidence-Based Policy Resource Center (PEPReC) and from a 2019 survey of interdisciplinary pain management teams at VHA facilities. Prescribing data are reported quarterly until first quarter fiscal year 2020 (Q1FY2020), ending December 31, 2019.
Program Evaluation: VHA opioid dispensing peaked in 2012 with 679,376 Veterans receiving an opioid prescription, and when including tramadol, in 2013 with 869,956 Veterans. Since 2012, the number of Veterans dispensed an opioid decreased 56% and co-prescribed opioid/benzodiazepine decreased 83%. Veterans with high-dose opioids (≥ 100 mg morphine equivalent daily dose) decreased 77%. In Q1FY2020, among Veterans on long-term opioid therapy (LTOT), 91.1% had written informed consent, 90.8% had a urine drug screen, and 89.0% had a prescription drug monitoring program query. Naloxone was issued to 217,469 Veterans and resulted in > 1,000 documented overdose reversals. In 2019, interdisciplinary pain management teams were fully designated at 68%, partially designated at 28%, and not available at 4% of 140 VA parent facilities. Fifty percent of Veterans on opioids at very high risk for overdose/suicide received interdisciplinary team reviews.
Implications: VHA clinicians have greatly reduced their volume of opioid prescribing for pain management and expanded implementation of opioid risk mitigation strategies.
Impacts: VHA's integrated health care system provides a model for opioid stewardship and interdisciplinary pain care.
