Academic Detailing Service, Pharmacy Benefits Management Services, US Department of Veterans Affairs, San Diego, California, USA.
The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA.
Subst Abus. 2020;41(1):101-109. doi: 10.1080/08897077.2019.1573777. Epub 2019 Mar 14.
Benzodiazepine use in the US Veterans Administration (VA) has been decreasing; however, a small number of veterans with posttraumatic stress disorder (PTSD) continue to receive benzodiazepine. Academic detailing, a targeted-educational outreach intervention, was implemented at VA to help reduce the disparity between existing and evidence-based practices, including the reduction in benzodiazepine use in veterans with PTSD. Since evidence to support the national implementation of academic detailing in this clinical scenario was scarce, we performed a quality improvement evaluation on academic detailing's impact on benzodiazepine use in veterans with PTSD. A retrospective cohort design was used to evaluate the impact of academic detailing on benzodiazepine prescribing in veterans with PTSD from January 1, 2016, to December 31, 2016. Providers exposed to academic detailing (AD-exposed) were compared with providers unexposed to academic detailing (AD-unexposed) using generalized estimating equations (GEEs) controlling for baseline covariates. Secondary aims evaluated academic detailing's impact on average lorazepam equivalent daily dose (LEDD), total LEDD, and benzodiazepine day supply. Overall, there was a decrease in the prevalence in benzodiazepine use in veterans with PTSD from 115.5 to 103.3 per 1000 population ( < .001). However, the decrease was greater in AD-exposed providers (18.37%; < .001) compared with AD-unexposed providers (8.74%; < .001). In the GEE models, AD-exposed providers had greater reduction in the monthly prevalence of veterans with PTSD and a benzodiazepine prescription compared with AD-unexposed providers, by -1.30 veterans per 1000 population (95% confidence interval [CI]: -2.14, -0.46). Similar findings were reported for the benzodiazepine day supply; however, no significant differences were reported for total and average LEDD. Although benzodiazepine use has been decreasing in veterans with PTSD, opportunities to improve prescribing continue to exist at the VA. In this quality improvement evaluation, AD-exposed providers were associated with a greater reduction in the prevalence of veterans with PTSD and a benzodiazepine prescription compared with AD-unexposed providers.
苯二氮䓬类药物在美国退伍军人事务部（VA）的使用正在减少；然而，仍有少数患有创伤后应激障碍（PTSD）的退伍军人在使用苯二氮䓬类药物。学术细化是一种有针对性的教育推广干预措施，已在 VA 实施，以帮助缩小现有实践与循证实践之间的差距，包括减少 PTSD 退伍军人使用苯二氮䓬类药物。由于缺乏支持在这一临床情况下在全国范围内实施学术细化的证据，我们对学术细化对 PTSD 退伍军人使用苯二氮䓬类药物的影响进行了质量改进评估。使用回顾性队列设计评估了 2016 年 1 月 1 日至 2016 年 12 月 31 日期间学术细化对 PTSD 退伍军人苯二氮䓬类药物处方的影响。接触学术细化（AD 暴露）的提供者与未接触学术细化（AD 未暴露）的提供者进行比较，使用广义估计方程（GEE）控制基线协变量。次要目标评估了学术细化对平均劳拉西泮等效日剂量（LEDD）、总 LEDD 和苯二氮䓬类药物日供应量的影响。总体而言，PTSD 退伍军人中苯二氮䓬类药物使用率从每 1000 人 115.5 人下降到 103.3 人（ < .001）。然而，AD 暴露提供者的下降幅度更大（18.37%； < .001），而 AD 未暴露提供者的下降幅度较小（8.74%； < .001）。在 GEE 模型中，AD 暴露提供者每月 PTSD 退伍军人和苯二氮䓬类药物处方的患病率下降幅度大于 AD 未暴露提供者，每 1000 人减少 1.30 人（95%置信区间[CI]：-2.14，-0.46）。苯二氮䓬类药物日供应量也有类似的报告；然而，总平均 LEDD 无显著差异。尽管 PTSD 退伍军人中苯二氮䓬类药物的使用有所减少，但 VA 仍有改善处方的机会。在这项质量改进评估中，与 AD 未暴露提供者相比，AD 暴露提供者与 PTSD 退伍军人和苯二氮䓬类药物处方的患病率下降幅度更大。
