Pardo Deborah, Miller Lacey, Chiulli Dana
a Veterans Affairs Palo Alto Health Care System (VAPAHCS) , Palo Alto , California , USA.
Subst Abus. 2017 Apr-Jun;38(2):157-160. doi: 10.1080/08897077.2017.1290011. Epub 2017 Feb 6.
The dangers of co-administration of opioid pain relievers (OPRs) and benzodiazepines (BZDs) are well documented. The combination of OPRs and BZDs make up the majority of medications involved in prescription drug-related overdose and are often used concomitantly. This pattern is consistent among the veteran population where mental health illness and substance abuse are prominent. The Veterans Health Administration implemented the Opioid Safety Initiative (OSI) aimed at improving patient safety surrounding OPRs. In alignment with OSI, the study facility implemented a prior authorization pharmacy consult in an effort to reduce OPR and BZD co-prescribing and optimize patient safety. The purpose of this article is to report the frequency of co-prescribing before and after implementation of the consult. Secondary aims include reporting the emergency room visits and hospitalizations, prescribers' actions in the setting of disapproved consults, patient characteristics associated with co-prescribing, and frequency of co-prescribing without a consult.
This was a single-center, retrospective chart review study. Microsoft Structured Query Language server database and Veterans Health Information Systems and Technology Architecture were used to extract data and identify study patients. The Computerized Patient Record System was used to collect patient data. Microsoft Access and Excel were utilized to organize, query, and analyze the extracted data.
There was a 34.6% reduction in patients on chronic OPR therapy co-prescribed a BZD, and the total number of overdose-related events decreased after implementation of the consult. In the event of disapproved consults, pharmacists' evidence-based recommendations were implemented 63% of the time. Patients for whom co-prescribing consults were placed were more likely to have mental health diagnoses.
Following implementation of a pharmacy consult, there was a reduction in co-prescribing and overdose-related events at the study facility.
阿片类镇痛药（OPR）与苯二氮䓬类药物（BZD）联合使用的风险已有充分记录。OPR与BZD的组合是与处方药相关过量用药的主要涉事药物，且常被同时使用。这种情况在心理健康疾病和药物滥用问题突出的退伍军人中很常见。退伍军人健康管理局实施了阿片类药物安全倡议（OSI），旨在提高围绕OPR的患者安全性。与OSI一致，研究机构实施了预先授权药房咨询，以减少OPR与BZD的联合处方并优化患者安全。本文旨在报告咨询实施前后联合处方的频率。次要目的包括报告急诊就诊和住院情况、在咨询未获批情况下开方者的行为、与联合处方相关的患者特征以及未经咨询的联合处方频率。
这是一项单中心回顾性病历审查研究。使用微软结构化查询语言服务器数据库以及退伍军人健康信息系统和技术架构来提取数据并识别研究患者。使用计算机化患者记录系统收集患者数据。利用微软Access和Excel来组织、查询和分析提取的数据。
接受慢性OPR治疗且同时开具BZD的患者减少了34.6%，咨询实施后与过量用药相关事件的总数有所下降。在咨询未获批的情况下，药师基于证据的建议有63%的时间得到了实施。接受联合处方咨询的患者更有可能被诊断患有精神疾病。
在实施药房咨询后，研究机构的联合处方及与过量用药相关的事件有所减少。
