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: 9888304
• 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/9888304
• 关键词: Address; Adopted; Adverse event; Affect; Affordable Care Act; Caring; Characteristics; Clinical; Collaborations; Complement; Data; Data Set; Delirium; Development; Dose; Drug Prescriptions; Educational process of instructing; Emergency department visit; Enrollment; Ensure; Exposure to; Future; Goals; Guideline Adherence; Health; Health Insurance; Health system; Healthcare; Healthcare Systems; Hospitals; Infrastructure; Insurance; Intervention; Interview; Knowledge; Link; Location; Measures; Mediating; Mediation; Medicaid; Medicare; Medicare/Medicaid; Mental Health; Methods; Monitor; Opioid; Opioid Analgesics; Outcome; Overdose; Pain; Pain Clinics; Pain management; Patients; Pattern; Perception; Pharmaceutical Preparations; Phase; Policies; Privatization; Provider; Quality of Care; Reporting; Research; Risk; Risk Management; Safety; Serious Adverse Event; Source; Structure; Time; Veterans; care providers; cohort; comorbidity; demographics; design; dosage; falls; health care availability; human old age (65+); hypnotic; improved; medical specialties; medication safety; milligram; morphine equivalent; multidisciplinary; non-opioid analgesic; opioid misuse; opioid overuse; opioid therapy; opioid use; overdose death; patient safety; pharmacy benefit; physical conditioning; prescription opioid; prevent; programs; real time monitoring; sedative; stakeholder perspectives; successful intervention; 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）： 过去十年中，退伍军人管理局医疗保健系统 (VA) 配发的阿片类药物数量增加了一倍多。近 25% 的 VA 患者接受 VA 的阿片类药物治疗，人们非常担心阿片类药物过度使用、服用过量和其他不良事件。 VA 已采取多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于监测 VA 内发放的处方。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药。随着《平价医疗法案》下医疗补助和私人保险的扩大，退伍军人事务部和非退伍军人事务部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。对于阿片类药物来说，双重使用的重要性被放大，这些药物具有独特的风险，当护理分散时，这些风险可能会放大。这项研究将与退伍军人管理局药房福利管理、退伍军人管理局药物安全中心和退伍军人管理局国家疼痛项目办公室合作，解决退伍军人阿片类药物使用理解中的这一严重缺陷。这项混合方法研究由两个定量目标（目标 1-2）和一个定性目标（目标 3）组成，将同时进行。目的是：(1) 描述在 VA 接受护理的退伍军人中使用 VA 和非 VA（即医疗保险、医疗补助）来源的阿片类药物的模式，并确定与阿片类药物双重使用相关的患者和设施特征； (2) 评估同时使用 VA 和非 VA 阿片类药物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； (3) 探讨提供者和其他利益相关者对识别和管理从事退伍军人事务部护理的退伍军人中阿片类药物双重使用的看法。定量阶段将涉及对来自 VA、医疗保险和医疗补助的多个关联数据集进行回顾性分析，这些数据集针对从任何这些来源填写阿片类药物的登记退伍军人。分析将检查阿片类药物的来源（即仅 VA、仅非 VA、VA 和非 VA）与患者和机构特征之间的关联。利用倾向评分、工具变量分析和多重中介路径分析，我们将检查阿片类药物的双重使用与阿片类药物安全性措施之间的关联，包括每天服用 >100 毫克吗啡当量、重复服用镇静/催眠药物，以及与阿片类药物相关的不良事件，包括过量死亡以及因过量服用医院或急诊室就诊、药物谵妄和跌倒。定性目标将通过对主要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）； (2) VA、医疗保险、医疗补助和私人保险领域利益相关者领导人的观点，以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 提供及时且有价值的信息，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，该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使用阿片类药物。

项目成果

Opioid-related emergency department visits and hospitalizations among patients with chronic gastrointestinal symptoms and disorders dually enrolled in the Department of Veterans Affairs and Medicare Part D.

退伍军人事务部和医疗保险 D 部分双重登记的患有慢性胃肠道症状和疾病的患者与阿片类药物相关的急诊就诊和住院情况。

• DOI: 10.1093/ajhp/zxab363
• 发表时间: 2022
• 期刊: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
• 作者: Balbale,SalvaN;Cao,Lishan;Trivedi,Itishree;Stulberg,JonahJ;Suda,KatieJ;Gellad,WalidF;Evans,CharlesnikaT;Jordan,Neil;Keefer,LaurieA;Lambert,BruceL
• 通讯作者: Lambert,BruceL

Primary care physicians' perspectives on Veterans who obtain prescription opioids from multiple healthcare systems.

初级保健医生对从多个医疗系统获取处方阿片类药物的退伍军人的看法。

• DOI: 10.5055/jom.2019.0502
• 发表时间: 2019
• 期刊: Journal of opioid management
• 作者: Bixler,FeliciaR;Radomski,ThomasR;Zickmund,SusanL;Roman,KatieLynnM;Hausmann,LeslieRM;Thorpe,CarolynT;Hale,JenniferA;Sileanu,FlorentinaE;Gellad,WalidF
• 通讯作者: Gellad,WalidF

Identifying sociodemographic profiles of veterans at risk for high-dose opioid prescribing using classification and regression trees.

确定使用分类和回归树的高剂量阿片类药物处方的退伍军人的社会人口统计学概况。

• DOI: 10.5055/jom.2020.0599
• 发表时间: 2020-11
• 期刊: Journal of opioid management
• 作者: Lipkin JS;Thorpe JM;Gellad WF;Hanlon JT;Zhao X;Thorpe CT;Sileanu FE;Cashy JP;Hale JA;Mor MK;Radomski TR;Good CB;Fine MJ;Hausmann LRM
• 通讯作者: Hausmann LRM