U.S. Department of Veterans Affairs (VA) Pharmacy Benefits Management (PBM) Academic Detailing Service, Washington, District of Columbia, USA.
U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California, USA.
Pain Med. 2021 Jun 4;22(6):1426-1434. doi: 10.1093/pm/pnaa475.
To assess the process and outcomes of academic detailing to enhance the Opioid Safety Initiative and the Psychotropic Drug Safety Initiative to reduce co-prescribing of opioid-benzodiazepine combinations in veterans.
A retrospective cohort design was conducted to evaluate the impact of implementing an academic detailing program on opioid-benzodiazepine co-prescribing between October 2014 through March 2019 at the U.S. Department of Veterans Affairs (VA). The primary outcome was the monthly prevalence of veterans (number per 1,000 population) who were co-prescribed opioid-benzodiazepine combination. Process measure was evaluated using implementation reach (proportion of providers who received academic detailing). Station-level analysis was performed using a linear fixed effects regression model to evaluate the rate of change in the prevalence of veterans co-prescribed opioid-benzodiazepine.
Altogether 130 VA stations was included for analysis; 119 stations implemented opioid-related or benzodiazepine-related academic detailing, and 11 stations did not. Stations that had implemented academic detailing had a 33% greater monthly reduction on the opioid-benzodiazepine co-prescribing prevalence compared to stations that did not implement academic detailing (P = .036). In the linear fixed effects regression model, stations that were expected to have 100% of providers exposed to academic detailing were statistically associated with a greater decrease in the monthly prevalence of Veterans co-prescribed opioid-benzodiazepine by 4.9 veterans per 1,000 population (P < .001) compared to stations with 0% of providers exposed to academic detailing.
Stations that implemented academic detailing and had a higher proportion of providers who were exposed to opioid- or benzodiazepine-related academic detailing had a significant decrease in the monthly prevalence of Veterans co-prescribed opioid-benzodiazepine combinations.
评估学术细化的过程和结果，以加强阿片类药物安全倡议和精神药物安全倡议，减少退伍军人中阿片类药物-苯二氮䓬类药物联合用药。
采用回顾性队列设计，评估 2014 年 10 月至 2019 年 3 月期间在美国退伍军人事务部（VA）实施学术细化项目对阿片类药物-苯二氮䓬类药物联合用药的影响。主要结果是每月同时使用阿片类药物和苯二氮䓬类药物的退伍军人人数（每千人中的人数）。采用实施范围（接受学术细化的提供者比例）评估过程指标。使用线性固定效应回归模型对站点水平进行分析，以评估退伍军人同时使用阿片类药物和苯二氮䓬类药物的流行率的变化率。
共纳入 130 个 VA 站点进行分析；119 个站点实施了阿片类药物相关或苯二氮䓬类药物相关的学术细化，11 个站点没有实施。与未实施学术细化的站点相比，实施学术细化的站点每月减少阿片类药物-苯二氮䓬类药物联合用药的流行率增加 33%（P = .036）。在线性固定效应回归模型中，预计将有 100%的提供者接受学术细化的站点与每月接受阿片类药物-苯二氮䓬类药物联合治疗的退伍军人人数减少 4.9 人/千人（P < .001）统计学相关，相比之下，接受学术细化的提供者比例为 0%的站点。
实施学术细化且有更多接受阿片类药物或苯二氮䓬类药物相关学术细化的提供者的站点，退伍军人同时使用阿片类药物和苯二氮䓬类药物的流行率每月显著下降。
