退伍军人事务部的阿片类药物处方和阿片类药物风险缓解策略。
Opioid Prescribing and Opioid Risk Mitigation Strategies in the Veterans Health Administration.
机构信息
Pain Management and Opioid Safety Program, Veterans Health Administration, Washington, DC, USA.
Department of Neurology, Washington DC VA Medical Center, Washington, DC, USA.
出版信息
J Gen Intern Med. 2020 Dec;35(Suppl 3):927-934. doi: 10.1007/s11606-020-06258-3. Epub 2020 Nov 16.
INTRODUCTION
The Veterans Health Administration (VHA) has taken a multifaceted approach to addressing opioid safety and promoting system-wide opioid stewardship.
AIM
To provide a comprehensive evaluation of current opioid prescribing practices and implementation of risk mitigation strategies in VHA.
SETTING
VHA is the largest integrated health care system in the United States.
PROGRAM DESCRIPTION
VHA prescribing data in conjunction with implementation of opioid risk mitigation strategies are routinely tracked and reviewed by VHA's Pharmacy Benefits Management Services (including Academic Detailing Service) and the Pain Management Program Office. Additional data are derived from the Partnered Evidence-Based Policy Resource Center (PEPReC) and from a 2019 survey of interdisciplinary pain management teams at VHA facilities. Prescribing data are reported quarterly until first quarter fiscal year 2020 (Q1FY2020), ending December 31, 2019.
PROGRAM EVALUATION
VHA opioid dispensing peaked in 2012 with 679,376 Veterans receiving an opioid prescription, and when including tramadol, in 2013 with 869,956 Veterans. Since 2012, the number of Veterans dispensed an opioid decreased 56% and co-prescribed opioid/benzodiazepine decreased 83%. Veterans with high-dose opioids (≥ 100 mg morphine equivalent daily dose) decreased 77%. In Q1FY2020, among Veterans on long-term opioid therapy (LTOT), 91.1% had written informed consent, 90.8% had a urine drug screen, and 89.0% had a prescription drug monitoring program query. Naloxone was issued to 217,469 Veterans and resulted in > 1,000 documented overdose reversals. In 2019, interdisciplinary pain management teams were fully designated at 68%, partially designated at 28%, and not available at 4% of 140 VA parent facilities. Fifty percent of Veterans on opioids at very high risk for overdose/suicide received interdisciplinary team reviews.
IMPLICATIONS
VHA clinicians have greatly reduced their volume of opioid prescribing for pain management and expanded implementation of opioid risk mitigation strategies.
IMPACTS
VHA's integrated health care system provides a model for opioid stewardship and interdisciplinary pain care.
简介
退伍军人健康管理局（VHA）采取了多方面的方法来解决阿片类药物安全问题，并促进全系统的阿片类药物管理。
目的
全面评估 VHA 中目前的阿片类药物处方实践和实施风险缓解策略的情况。
设置
VHA 是美国最大的综合医疗保健系统。
计划描述
VHA 的处方数据与阿片类药物风险缓解策略的实施一起，由 VHA 的药房福利管理服务（包括学术详细服务）和疼痛管理计划办公室定期跟踪和审查。其他数据来自合作伙伴循证政策资源中心（PEPReC）和 2019 年对 VHA 设施跨学科疼痛管理团队的调查。处方数据每季度报告一次，直到 2020 财年第一季度（Q1FY2020），截至 2019 年 12 月 31 日。
计划评估
VHA 的阿片类药物配药在 2012 年达到顶峰，有 679376 名退伍军人接受了阿片类药物处方，包括曲马多在内，2013 年有 869956 名退伍军人。自 2012 年以来，接受阿片类药物配药的退伍军人人数减少了 56%，同时联合开具阿片类药物/苯二氮䓬类药物的处方减少了 83%。高剂量阿片类药物（≥100mg 吗啡当量日剂量）的退伍军人减少了 77%。在 2020 财年第一季度，接受长期阿片类药物治疗（LTOT）的退伍军人中，91.1%有书面知情同意书，90.8%有尿液药物筛查，89.0%有处方药物监测计划查询。有 217469 名退伍军人获得了纳洛酮，并有超过 1000 例记录在案的药物过量逆转。2019 年，跨学科疼痛管理团队在 140 家 VA 母公司设施中完全指定的占 68%，部分指定的占 28%，不可用的占 4%。50%的阿片类药物超高风险自杀/过量的退伍军人接受了跨学科团队评估。
结论
VHA 的临床医生大大减少了他们开具阿片类药物治疗疼痛的处方量，并扩大了阿片类药物风险缓解策略的实施。
影响
VHA 的综合医疗保健系统为阿片类药物管理和跨学科疼痛护理提供了一个模式。
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