Safety of Opioid use Among Veterans Receiving Care in Multiple Health Systems

在多个卫生系统接受护理的退伍军人使用阿片类药物的安全性

• 批准号: 9015268
• 负责人: Walid F. Gellad
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-01 至 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9015268
• 关键词: Address; Address; Adopted; Adopted; Adverse event; Adverse event; Affect; Affect; Affordable Care Act; Caring; Caring; Characteristics; Characteristics; Clinical; Clinical; Collaborations; Collaborations; Comorbidity; Comorbidity; Complement; Complement; Data; Data; Data Set; Data Set; Delirium; Delirium; Development; Development; Dose; Dose; Educational process of instructing; Educational process of instructing; Elderly; Emergency department visit; Emergency department visit; Enrollment; Enrollment; Ensure; Ensure; Exposure to; Exposure to; Future; Future; Goals; Goals; Guideline Adherence; Guideline Adherence; Health; Health; Health Insurance; Health Insurance; Health system; Health system; Healthcare; Healthcare; Healthcare Systems; Healthcare Systems; Hospitals; Hospitals; Infrastructure; Insurance; Insurance; Intervention; Intervention; Interview; Interview; Knowledge; Knowledge; Link; Link; Location; Location; Measures; Measures; Mediating; Mediating; Mediation; Mediation; Medicaid; Medicaid; Medicare; Medicare; Medicare/Medicaid; Medicare/Medicaid; Mental Health; Mental Health; Methods; Methods; Monitor; Monitor; Morphine; Opioid; Opioid; Opioid Analgesics; Outcome; Outcome; Overdose; Overdose; Pain; Pain; Pain Clinics; Pain Clinics; Pain management; Pain management; Patients; Patients; Pattern; Pattern; Perception; Perception; Pharmaceutical Preparations; Pharmaceutical Preparations; Phase; Phase; Policies; Policies; Primary Health Care; Privatization; Provider; Provider; Quality of Care; Quality of Care; Reporting; Reporting; Research; Research; Research Infrastructure; Risk; Risk; Risk Management; Safety; Safety; Serious Adverse Event; Serious Adverse Event; Source; Source; Structure; Structure; Time; Time; Veterans; Veterans; care providers; cohort; cohort; demographics; demographics; design; design; dosage; dosage; falls; falls; health care availability; health care availability; human old age (65+); hypnotic; hypnotic; improved; improved; medical specialties; medical specialties; medication safety; milligram; milligram; morphine equivalent; multidisciplinary; multidisciplinary; non-opioid analgesic; opioid misuse; opioid misuse; opioid overuse; opioid therapy; opioid use; opioid use; overdose death; overdose death; patient safety; patient safety; pharmacy benefit; pharmacy benefit; physical conditioning; physical conditioning; prescription opioid; prevent; prevent; programs; programs; real time monitoring; sedative; sedative; successful intervention; successful intervention; trend; trend

 DESCRIPTION (provided by applicant): The number of opioid medications dispensed in the VA Healthcare System (VA) has more than doubled in the last decade. Almost 25% of VA patients receive an opioid medication from VA, and there is great concern about opioid overuse, overdose, and other adverse events. VA has adopted several strategies to mitigate the risks of opioid-related adverse events, but these efforts focus almost entirely on monitoring prescriptions dispensed within VA. More than 75% of Veterans have other forms of health insurance and can access healthcare and prescriptions in non-VA settings. Dual use of VA and non-VA health care and prescription benefits is likely to increase over time with the expansion of Medicaid and private insurance under the Affordable Care Act. The importance of dual use is magnified for opioid medications, which have unique risks that may be amplified when care is fragmented. In partnership with VA Pharmacy Benefits Management, the VA Center for Medication Safety, and the VA National Pain Program Office, this study will address this critical deficiency in the understanding of opioid use in Veterans. Ths mixed methods study consists of two quantitative aims (Aims 1-2) and one qualitative aim (Aim 3), that will be conducted in parallel. The aims are to: (1) describe the patterns of opioid use from VA and non-VA (i.e., Medicare, Medicaid) sources among Veterans receiving care in the VA and identify patient and facility characteristics associated with dual use of opioid medications; (2) evaluate the impact of dual use of VA and non-VA opioid medications on opioid safety and opioid-related serious adverse events; and (3) explore provider and other stakeholder perspectives on identifying and managing dual use of opioid medications among Veterans engaged in VA care. The quantitative phase will involve retrospective analyses of multiple linked datasets from VA, Medicare, and Medicaid for enrolled Veterans who filled an opioid medication from any of those sources. Analyses will examine the association between the source of opioids (i.e., VA only, non- VA only, both VA and non-VA) and patient and facility characteristics. Using propensity score and instrumental variable analyses and multiple mediation path analyses, we will examine the association between dual use of opioid medications and measures of opioid safety, including receipt of >100mg morphine equivalents daily, receipt of overlapping sedative/hypnotic medications, and opioid-related adverse events including overdose death and hospital or emergency room visits for overdose, drug delirium, and falls. The qualitative aim will complement these quantitative aims with two phases of semi-structured interviews of key stakeholders, exploring: (1) provider perceptions about identifying and managing dual use of opioid medications (Phase 1); and (2) the views of stakeholder leaders in VA, Medicare, Medicaid, and private insurance to interpret and synthesize the quantitative and qualitative results to maximize their relevance and impact on policy and future interventions (Phase 2). Together, these analyses will provide VA with timely and valuable information critical to understanding patterns, influences, and outcomes associated with dual use of opioid medications. The study will thus fill a crucial gap in evidence needed for development of optimal policy and clinical interventions to ensure the safe and appropriate use of opioids by Veterans.

 描述（由申请人提供）： 在过去十年中，VA医疗保健系统（VA）中分发的阿片类药物数量增加了一倍多。几乎25%的VA患者从VA接受阿片类药物治疗，并且非常关注阿片类药物过度使用，过量和其他不良事件。VA已经采取了几种策略来减轻阿片类药物相关不良事件的风险，但这些努力几乎完全集中在监测VA内分发的处方。超过75%的退伍军人拥有其他形式的健康保险，并且可以在非VA环境中获得医疗保健和处方。随着《平价医疗法案》下医疗补助和私人保险的扩大，VA和非VA医疗保健和处方福利的双重使用可能会随着时间的推移而增加。双重用途的重要性对于阿片类药物来说是放大的，阿片类药物具有独特的风险，当护理分散时可能会放大。与VA药房福利管理，VA药物安全中心和VA国家疼痛计划办公室合作，这项研究将解决这一关键缺陷，以了解退伍军人中阿片类药物的使用。混合方法研究包括两个定量目标（目标1-2）和一个定性目标（目标3），将平行进行。目的是：（1）描述VA和非VA的阿片类药物使用模式（即，（2）评估VA和非VA阿片类药物双重使用对阿片类药物安全性和阿片类药物相关严重不良事件的影响;和（3）探讨供应商和其他利益相关者的观点，确定和管理阿片类药物的双重使用退伍军人从事VA护理。定量阶段将涉及对来自VA，Medicare和Medicaid的多个关联数据集的回顾性分析，这些数据集用于从任何这些来源填充阿片类药物的注册退伍军人。分析将检查阿片类药物来源（即，仅VA、仅非VA、VA和非VA）以及患者和机构特征。使用倾向评分和工具变量分析以及多中介路径分析，我们将检查阿片类药物双重使用与阿片类药物安全性指标之间的相关性，包括每日接受> 100 mg吗啡当量，接受重叠的镇静/催眠药物，以及阿片类药物相关不良事件，包括过量死亡和因过量、药物性谵妄和福尔斯而前往医院或急诊室就诊。定性目标将通过对关键利益相关者进行两个阶段的半结构化访谈来补充这些定量目标，探索：（1）提供者对识别和管理阿片类药物双重使用的看法（第1阶段）;以及（2）VA，Medicare，Medicaid，和私人保险来解释和综合定量和定性结果，以最大限度地提高其对政策和未来干预措施的相关性和影响（第二阶段）.总之，这些分析将为VA提供及时和有价值的信息，这些信息对于了解与阿片类药物双重使用相关的模式，影响和结果至关重要。因此，这项研究将填补制定最佳政策和临床干预措施所需证据的关键空白，以确保退伍军人安全和适当地使用阿片类药物。