Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, 200 Springs Rd, Bedford, MA 01730. Email:
Am J Manag Care. 2018 Nov;24(11):536-540.
The aim of this study was to evaluate whether veterans in Massachusetts receiving opioids and/or benzodiazepines from both Veterans Health Administration (VHA) and non-VHA pharmacies are at higher risk of adverse events compared with those receiving opioids at VHA pharmacies only.
A cohort study of veterans who filled a prescription for any Schedule II through V substance at a Massachusetts VHA pharmacy. Prescriptions were recorded in the Massachusetts Department of Public Health Chapter 55 data set.
The study sample included 16,866 veterans residing in Massachusetts, of whom 9238 (54.8%) received controlled substances from VHA pharmacies only and 7628 (45.2%) had filled prescriptions at both VHA and non-VHA pharmacies ("dual care users") between October 1, 2013, and December 31, 2015. Our primary outcomes were nonfatal opioid overdose, fatal opioid overdose, and all-cause mortality.
Compared with VHA-only users, more dual care users resided in rural areas (12.6% vs 10.6%), received high-dose opioid therapy (26.3% vs 7.3%), had concurrent prescriptions of opioids and benzodiazepines (34.8% vs 8.2%), and had opioid use disorder (6.8% vs 1.6%) (P <.0001 for all). In adjusted models, dual care users had higher odds of nonfatal opioid overdose (odds ratio [OR], 1.29; 95% CI, 0.98-1.71) and all-cause mortality (OR, 1.66; 95% CI, 1.43-1.93) compared with VHA-only users. Dual care use was not associated with fatal opioid overdoses.
Among veterans in Massachusetts, receipt of opioids from multiple sources was associated with worse outcomes, specifically nonfatal opioid overdose and mortality. Better information sharing between VHA and non-VHA pharmacies and prescribers has the potential to improve patient safety.
本研究旨在评估在马萨诸塞州，同时从退伍军人健康管理局（VHA）和非 VHA 药房获取阿片类药物和/或苯二氮䓬类药物的退伍军人与仅从 VHA 药房获取阿片类药物的退伍军人相比，发生不良事件的风险是否更高。
这是一项对在马萨诸塞州 VHA 药房开处方任何 II 至 V 类药物的退伍军人进行的队列研究。处方记录在马萨诸塞州公共卫生部第 55 章数据集中。
研究样本包括居住在马萨诸塞州的 16866 名退伍军人，其中 9238 人（54.8%）仅从 VHA 药房获取受控物质，7628 人（45.2%）在 2013 年 10 月 1 日至 2015 年 12 月 31 日期间同时在 VHA 和非 VHA 药房开处方（“双重护理使用者”）。我们的主要结局是非致命性阿片类药物过量、致命性阿片类药物过量和全因死亡率。
与 VHA 单一使用者相比，更多的双重护理使用者居住在农村地区（12.6%比 10.6%），接受高剂量阿片类药物治疗（26.3%比 7.3%），同时开阿片类药物和苯二氮䓬类药物处方（34.8%比 8.2%），以及阿片类药物使用障碍（6.8%比 1.6%）（均<.0001）。在调整后的模型中，与 VHA 单一使用者相比，双重护理使用者发生非致命性阿片类药物过量的可能性更高（比值比[OR]，1.29；95%置信区间[CI]，0.98-1.71）和全因死亡率（OR，1.66；95% CI，1.43-1.93）。双重护理使用与致命性阿片类药物过量无关。
在马萨诸塞州的退伍军人中，从多个来源获取阿片类药物与更差的结果相关，特别是非致命性阿片类药物过量和死亡率。改善 VHA 和非 VHA 药房和开处方者之间的信息共享有可能提高患者安全性。
