Medication Use Evaluation of High-Dose Long-Term Opioid De-prescribing in Multiple Veterans Affairs Medical Centers.

Autor: Barrett AK; VA Pharmacy Benefits Management Services and Center for Medication Safety, Hines VA, Hines, IL, USA. alexis.barrett@va.gov.; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C) Building 30, Pittsburgh, PA, 15240, USA. alexis.barrett@va.gov., Sandbrink F; Washington DC VA Medical Center, Washington, DC, USA., Mardian A; Phoenix VA Healthcare System, Phoenix, AZ, USA., Oliva EM; VA Program Evaluation and Resource Center, Menlo Park, CA, USA.; VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA., Torrise V; VA Pharmacy Benefits Management Services, United States Department of Veterans Affairs, Washington, DC, USA., Zhang R; VA Pharmacy Benefits Management Services and Center for Medication Safety, Hines VA, Hines, IL, USA., Bukowski K; VA Pharmacy Benefits Management Services and Center for Medication Safety, Hines VA, Hines, IL, USA., Burk M; VA Pharmacy Benefits Management Services and Center for Medication Safety, Hines VA, Hines, IL, USA., Cunningham FE; VA Pharmacy Benefits Management Services and Center for Medication Safety, Hines VA, Hines, IL, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2022 Dec; Vol. 37 (16), pp. 4037-4046. Date of Electronic Publication: 2022 Oct 11.
DOI: 10.1007/s11606-022-07807-8
Abstrakt: Background: The Opioid Safety Initiative (OSI) was implemented in 2013 to enhance the safe and appropriate use of opioids in the Veterans Health Administration (VA). Opioid use decreased nationally in subsequent years, but characterization of opioid de-prescribing practices has not been well established.
Objectives: To describe changes in patient characteristics and patterns of de-prescribing since OSI implementation for opioid users at > 90 morphine equivalent daily dose for at least 90 days for those that discontinued opioids within the VA.
Design: Retrospective observational pre-post intervention medication use evaluation using VA data and electronic health records to identify differences in opioid de-prescribing between fiscal year 2013 (FY13; early OSI) and FY17 (late OSI). Reviewers' insights for local opioid management and de-prescribing practices collected through web-based post-data collection survey.
Participants: Veterans prescribed high-dose long-term opioid therapy in FY13 and FY17 who subsequently discontinued opioids at 27 VA medical centers.
Main Measures: Chart review data from local facility reviewers identified socioeconomic characteristics, opioid de-prescribing rationale (e.g., risk-benefit, diversion) and practices (e.g., rate of opioid discontinuation, taper monitoring activities, withdrawal monitoring), and outcomes following discontinuation.
Key Results: Among 315 patients in FY13 and 322 patients in FY17 with opioid discontinuation, discontinuation rationale focused on diversion in FY13 and risk-benefit in FY17. Clinical pharmacists and pain management specialists had increased involvement in FY17 opioid discontinuations (36% versus 16%). Of all discontinuations, 56% of patients were tapered in FY13 versus 70% of patients in FY17. Tapering plans were longer in FY17 than in FY13 (163 days versus 65 days). Transitions to non-opioid pain therapy following opioid discontinuation were higher in FY17 compared to FY13 (70% versus 60%).
Conclusions: Veterans discontinued from high-dose long-term opioids in FY17 were more optimally managed compared to those in FY13. Findings suggest improvements in opioid de-prescribing following OSI implementation, but interpretation is limited by study design.
(© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
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