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Implementation of Opioid Safety Efforts: Influence of Academic Detailing on Adverse Outcomes Among Patients in the Veterans Health Administration.
Williams, Emily C; Frost, Madeline C; Bounthavong, Mark; Edmonds, Amy T; Lau, Marcos K; Edelman, E Jennifer; Harvey, Michael A; Christopher, Melissa L D.
Afiliación
  • Williams EC; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
  • Frost MC; Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
  • Bounthavong M; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
  • Edmonds AT; Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
  • Lau MK; Academic Detailing Service, Pharmacy Benefits Management, Veterans Health Administration, Department of Veterans Affairs Central Office, Washington, DC, USA.
  • Edelman EJ; VA Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA.
  • Harvey MA; UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA.
  • Christopher MLD; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
Subst Use Addctn J ; 45(4): 610-623, 2024 Oct.
Article en En | MEDLINE | ID: mdl-38634339
ABSTRACT

BACKGROUND:

The Veterans Health Administration (VA) implemented academic detailing (AD) to support safer opioid prescribing and overdose prevention initiatives.

METHODS:

Patient-level data were extracted monthly from VA's electronic health record to evaluate whether AD implementation was associated with changes in all-cause mortality, opioid poisoning inpatient admissions, and opioid poisoning emergency department (ED) visits in an observational cohort of patients with long-term opioid prescriptions (≥45-day supply of opioids 6 months prior to a given month with ≤15 days between prescriptions). A single-group interrupted time series analysis using segmented logistic regression for mortality and Poisson regression for counts of inpatient admissions and ED visits was used to identify whether the level and slope of these outcomes changed in response to AD implementation.

RESULTS:

Among 955 376 unique patients (19 431 241 person-months), there were 53 369 deaths (29 025 pre-AD; 24 344 post-AD), 1927 opioid poisoning inpatient admissions (610 pre-AD; 1317 post-AD), and 408 opioid poisoning ED visits (207 pre-AD; 201 post-AD). Immediately after AD implementation, there was a 5.8% reduction in the odds of all-cause mortality (95% confidence interval [CI] 0.897, 0.990). However, patients had a significantly increased incidence rate of inpatient admissions for opioid poisoning immediately after AD implementation (incidence rate ratio = 1.523; 95% CI 1.118, 2.077). No significant differences in ED visits for opioid poisoning were observed.

CONCLUSIONS:

AD was associated with decreased all-cause mortality but increased inpatient hospitalization for opioid poisoning among patients prescribed long-term opioids. Mechanisms via which AD's efforts influenced opioid-related outcomes should be explored.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: United States Department of Veterans Affairs / Servicio de Urgencia en Hospital / Analgésicos Opioides Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Subst Use Addctn J Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: United States Department of Veterans Affairs / Servicio de Urgencia en Hospital / Analgésicos Opioides Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Subst Use Addctn J Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos