Buscaglia Alexander C, Paik Meenah C, Lewis Eleanor, Trafton Jodie A
Department of Veterans Affairs, Center for Innovation to Implementation, Menlo Park.
Department of Psychiatry and Behavioral Sciences and Center for Health Policy, Stanford University School of Medicine, Stanford, CA.
Clin J Pain. 2015 Sep;31(9):803-812. doi: 10.1097/AJP.0000000000000160.
The purpose of this study was to determine baseline adherence to key recommendations from the 2010 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Pain at Veterans Health Administration (VA) facilities. We hoped to understand practice patterns at the time of guideline release to guide quality improvement and implementation efforts.
Overall practice patterns were examined at each of the 140 VA Health Care Systems based on quality metrics developed to assess adherence to the VA/DOD Clinical Practice Guideline.
Clinical practice varied widely across facilities on measures of use of urine drug screens, substance use disorder treatment for diagnosed substance use disorder patients, and use of rehabilitative treatments. Less variation was observed in measures of sedative coprescription and use of adjunctive pharmacotherapy. Use of guideline recommended practices was generally more frequent for patients prescribed long-acting opioid formulations and those with chronic use. Relative facility-level implementation was correlated across most measures. Overall implementation of guideline recommended practices was lower at less complex facilities and facilities in the Western United States.
In 2010, guideline-recommended practices for opioid prescribing were variably used across VA health care systems. Efforts to disseminate practices used at high-performing sites, and increase consistency of use of recommended practices across patients and facilities should be considered to improve pain management and reduce adverse events.
本研究旨在确定退伍军人健康管理局（VA）设施对2010年VA/国防部慢性疼痛阿片类药物治疗临床实践指南关键建议的基线依从性。我们希望了解指南发布时的实践模式，以指导质量改进和实施工作。
基于为评估对VA/国防部临床实践指南的依从性而制定的质量指标，对140个VA医疗系统中的每一个的总体实践模式进行了检查。
在尿液药物筛查的使用、对诊断为物质使用障碍患者的物质使用障碍治疗以及康复治疗的使用等措施方面，各机构的临床实践差异很大。在镇静剂联合处方和辅助药物治疗的使用措施方面观察到的差异较小。对于开具长效阿片类药物制剂的患者和长期使用的患者，指南推荐做法的使用通常更为频繁。大多数措施的相对机构层面实施情况存在相关性。在不太复杂的机构和美国西部的机构中，指南推荐做法的总体实施率较低。
2010年，VA医疗系统对阿片类药物处方的指南推荐做法使用情况各不相同。应考虑努力传播高绩效站点使用的做法，并提高患者和机构之间推荐做法使用的一致性，以改善疼痛管理并减少不良事件。
