Impact of Implementing an Academic Detailing Program on Opioid-Benzodiazepine Co-Prescribing Trends at the U.S. Department of Veterans Affairs.
Impact of Implementing an Academic Detailing Program on Opioid-Benzodiazepine Co-Prescribing Trends at the U.S. Department of Veterans Affairs.
复制标题
美国退伍军人事务部实施学术详细计划对阿片类药物-苯二氮卓类药物联合处方趋势的影响。
DOI：
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
M. Christopher
中科院分区：
文献类型：
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作者：
M. Bounthavong;Marcos K. Lau;Chad L. Kay;Daina L. Wells;Sarah J. Popish;Michael A. Harvey;J. Himstreet;Andrea Grana;Blake A. Freeman;Christina M. Morillo;M. Christopher
目标
评估学术细节的过程和结果，以加强阿片类药物安全倡议和精神药物安全倡议，以减少退伍军人中阿片类药物和苯二氮卓类药物的联合处方。
方法
为了评估2014年10月至2019年3月期间在美国退伍军人事务部(VA)实施的阿片类药物-苯二氮卓类药物联合处方学术详细计划的影响，进行了一项回溯性队列设计。主要结果是每月服用阿片类药物和苯二氮卓类药物联合处方的退伍军人的患病率(每1000人中有多少人)。使用实施范围(接受学术详细说明的提供者的比例)对过程测量进行评估。使用线性固定效应回归模型进行站水平分析，以评估退伍军人联合处方阿片类药物-苯二氮卓类药物的患病率的变化率。
结果
共有130个退伍军人站被纳入分析；119个站实施了与阿片类药物或苯二氮类药物相关的学术细节，11个站没有。与没有实施学术细节的站点相比，实施学术细节的站点每月阿片类药物-苯二氮卓类药物联合处方流行率下降33%(P = .036)。在线性固定效应回归模型中，预计100%的提供者暴露于学术细节的站点在统计学上与退伍军人每月联合处方阿片类药物-苯二氮卓类药物的患病率每千人下降4.9名退伍军人相关(P <； .001)，而与0%提供者暴露于学术细节的站点相比。
结论
实施学术细节并有较高比例的提供者接触阿片类药物或苯二氮卓类药物相关学术细节的站点，退伍军人联合处方阿片类药物-苯二氮卓类药物组合的月流行率显著下降。
OBJECTIVES
To assess the process and outcomes of academic detailing to enhance the Opioid Safety Initiative and the Psychotropic Drug Safety Initiative to reduce co-prescribing of opioid-benzodiazepine combinations in veterans.
METHODS
A retrospective cohort design was conducted to evaluate the impact of implementing an academic detailing program on opioid-benzodiazepine co-prescribing between October 2014 through March 2019 at the U.S. Department of Veterans Affairs (VA). The primary outcome was the monthly prevalence of veterans (number per 1,000 population) who were co-prescribed opioid-benzodiazepine combination. Process measure was evaluated using implementation reach (proportion of providers who received academic detailing). Station-level analysis was performed using a linear fixed effects regression model to evaluate the rate of change in the prevalence of veterans co-prescribed opioid-benzodiazepine.
RESULTS
Altogether 130 VA stations was included for analysis; 119 stations implemented opioid-related or benzodiazepine-related academic detailing, and 11 stations did not. Stations that had implemented academic detailing had a 33% greater monthly reduction on the opioid-benzodiazepine co-prescribing prevalence compared to stations that did not implement academic detailing (P = .036). In the linear fixed effects regression model, stations that were expected to have 100% of providers exposed to academic detailing were statistically associated with a greater decrease in the monthly prevalence of Veterans co-prescribed opioid-benzodiazepine by 4.9 veterans per 1,000 population (P < .001) compared to stations with 0% of providers exposed to academic detailing.
CONCLUSIONS
Stations that implemented academic detailing and had a higher proportion of providers who were exposed to opioid- or benzodiazepine-related academic detailing had a significant decrease in the monthly prevalence of Veterans co-prescribed opioid-benzodiazepine combinations.