Linkage of VA and State Prescription Drug Monitoring Program Data to Examine Concurrent Opioid and Sedative-Hypnotic Prescriptions among Veterans
Linkage of VA and State Prescription Drug Monitoring Program Data to Examine Concurrent Opioid and Sedative-Hypnotic Prescriptions among Veterans
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DOI：
10.1111/1475-6773.13025
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发表时间：
2018-12-01
影响因子：
3.4
通讯作者：
Cook, Lawrence J.
中科院分区：
文献类型：
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作者：
Carlson, Kathleen F.;Gilbert, Tess A.;Cook, Lawrence J.
目的了解俄勒冈州9/11事件后退伍军人同时使用退伍军人健康管理局(VA)和非VA处方阿片类药物和镇静催眠药物的情况。数据来源退伍军人医疗保健和处方数据与俄勒冈州处方药监测计划(PDMP)数据有概率联系。研究设计这项回溯性队列研究按年份(2014-2016)以及患者人口统计和临床特征检查了9/11事件后退伍军人n=19959人同时开出的处方。退伍军人被包括在队列中，他们在队列中接受退伍军人管理局的门诊护理；那些接受临终关怀或姑息治疗的人被排除在外。同时处方的定义为：阿片类药物和/或镇静催眠药的门诊处方重叠1天(分为苯二氮卓类和非苯二氮卓类)。主要研究结果是，在退伍军人管理局药房开出阿片类药物或镇静催眠药物处方的5882名退伍军人中，有1036人(17.6%)同时开出了来自非退伍军人管理局的处方。在药物类别中，分别有15.1%、8.8%和4.6%的患者同时接受VA和非VA阿片类药物、苯二氮类药物和非苯二氮类药物的治疗。退伍军人人口统计学和临床诊断与同时开药的可能性有关，参加退伍军人选择计划也是如此。结论在俄勒冈州接受退伍军人护理的911事件后，相当一部分退伍军人同时服用阿片类药物和镇静催眠药。护理的碎片化可能会导致退伍军人中处方药过量的风险。
Objective To examine the prevalence of concurrent Veterans Health Administration (VA) and non-VA prescriptions for opioids and sedative-hypnotic medications among post-9/11 veterans in Oregon. Data Sources VA health care and prescription data were probabilistically linked with Oregon Prescription Drug Monitoring Program (PDMP) data. Study Design This retrospective cohort study examined concurrent prescriptions among n = 19,959 post-9/11 veterans, by year (2014-2016) and by patient demographic and clinical characteristics. Veterans were included in the cohort for years in which they received VA outpatient care; those receiving hospice or palliative care were excluded. Concurrent prescriptions were defined as >= 1 days of overlap between outpatient prescriptions for opioids and/or sedative-hypnotics (categorized as benzodiazepines vs. non-benzodiazepines). Principal Findings Among 5,882 veterans who filled opioid or sedative-hypnotic prescriptions at VA pharmacies, 1,036 (17.6 percent) filled concurrent prescriptions from non-VA pharmacies. Within drug class, 15.1, 8.8, and 4.6 percent received concurrent VA and non-VA opioids, benzodiazepines, and non-benzodiazepines, respectively. Veteran demographics and clinical diagnoses were associated with the likelihood of concurrent prescriptions, as was enrollment in the Veterans Choice Program. Conclusions A considerable proportion of post-9/11 veterans receiving VA care in Oregon filled concurrent prescriptions for opioids and sedative-hypnotics. Fragmentation of care may contribute to prescription drug overdose risk among veterans.