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，VA 医疗系统 (VA) 配发的阿片类药物数量增加了一倍多，近 25% 的 VA 患者从 VA 接受阿片类药物治疗，人们非常担心阿片类药物过度使用、过量服用和其他不良反应。 VA 采取了多种策略来降低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控 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 VA 获得医疗保健和处方。非 VA 设置。双随着《平价医疗法案》下医疗补助和私人保险的扩大，退伍军人管理局和非退伍军人管理局医疗保健和处方福利的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，这种药物可能具有独特的风险。这项研究将与退伍军人事务部药房福利管理部、退伍军人事务部药物安全中心和退伍军人事务部国家疼痛计划办公室合作，解决退伍军人对阿片类药物使用的理解中的这一严重缺陷。两个定量目标中的一个（目标 1-2）和一个定性目标（目标 3）将同时进行，目的是：(1) 描述 VA 和非 VA（即医疗保险、医疗补助）来源的阿片类药物使用模式。在 VA 接受护理的退伍军人中，确定与双重使用阿片类药物相关的患者和机构特征；(2) 评估双重使用 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) 探索提供商和其他利益相关者参与 VA 护理的退伍军人中识别和管理阿片类药物双重使用的观点 该阶段将涉及对 VA、医疗保险和医疗补助中从任何这些来源填写阿片类药物的登记退伍军人的多个关联数据集进行定量回顾性分析。我们将使用倾向评分、工具变量分析和多重中介路径分析来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。阿片类药物双重使用之间的关联药物和阿片类药物安全措施，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、因过量服用医院或急诊室、药物谵妄和跌倒。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）；以及 (2) VA 利益相关者领导人的观点，医疗保险、医疗补助和私人保险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），这些分析将为 VA 提供及时且有价值的信息，对于理解模式和影响至关重要。以及与阿片类药物双重使用相关的结果，因此该研究将填补制定最佳政策和临床干预措施所需的证据的关键空白，以确保退伍军人安全和适当地使用阿片类药物。

项目成果

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。

• 发表时间: 2019
• 作者: Bixler, Felicia R;Radomski, Thomas R;Zickmund, Susan L;Roman, KatieLynn M;Hausmann, Leslie R M;Thorpe, Carolyn T;Hale, Jennifer A;Sileanu, Florentina E;Gellad, Walid F
• 通讯作者: Gellad, Walid F

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

使用分类和回归树确定有高剂量阿片类药物处方风险的退伍军人的社会人口统计特征。

• 发表时间: 2020-11
• 作者: Lipkin, Jacob S;Thorpe, Joshua M;Gellad, Walid F;Hanlon, Joseph T;Zhao, Xinhua;Thorpe, Carolyn T;Sileanu, Florentina E;Cashy, John P;Hale, Jennifer A;Mor, Maria K;Radomski, Thomas R;Good, Chester B;Fine, Michael J;Hausmann, Leslie R M
• 通讯作者: Hausmann, Leslie R M

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。

• 发表时间: 2022-01-05
• 作者: Balbale, Salva N;Cao, Lishan;Trivedi, Itishree;Stulberg, Jonah J;Suda, Katie J;Gellad, Walid F;Evans, Charlesnika T;Jordan, Neil;Keefer, Laurie A;Lambert, Bruce L
• 通讯作者: Lambert, Bruce L

The Veterans Choice Act and Dual Health System Use.

退伍军人选择法和双重医疗系统的使用。

• 发表时间: 2016-02
• 影响因子: 5.7
• 作者: Gellad; Walid F
• 通讯作者: Walid F

Patterns of opioid prescriptions received prior to unintentional prescription opioid overdose death among Veterans.

退伍军人在意外处方阿片类药物过量死亡之前收到的阿片类药物处方模式。

• 发表时间: 2019
• 作者: Moyo, Patience;Zhao, Xinhua;Thorpe, Carolyn T;Thorpe, Joshua M;Sileanu, Florentina E;Cashy, John P;Hale, Jennifer A;Mor, Maria K;Radomski, Thomas R;Donohue, Julie M;Hausmann, Leslie R M;Hanlon, Joseph T;Good, Chester B;Fine, Michael J;Gellad
• 通讯作者: Gellad