Avoundjian Tigran, Troszak Lara, Cohen Jennifer, Foglia Mary Beth, Trafton Jodie, Midboe Amanda
Center for Innovation to Implementation, Va Palo Alto Health Care System, Palo Alto, CA, USA.
School of Medicine, Stanford University, Stanford, CA, USA.
J Pain Res. 2022 May 25;15:1553-1562. doi: 10.2147/JPR.S317183. eCollection 2022.
To ensure all patients receiving long-term opioid therapy (LTOT) understand the risks, benefits and treatment alternatives, the Veterans Health Administration (VHA) released a national policy in 2014 to standardize a signature informed consent (SIC) process. We evaluated the impact of this policy on medical follow-up after LTOT initiation, a guideline recommended practice.
Using VHA administrative data, we identified patients initiating LTOT between May 2013 and May 2016. We used an interrupted time series design to compare the monthly rates of medical follow-up within 30 days and primary care visits within 3 months after LTOT initiation across three periods: 12 months before the policy (Year 1); 12 months after policy release (Year 2); and 12-24 months after policy release, when the SIC process was mandatory (Year 3).
Among the 409,895 patients who experienced 758,416 LTOT initiations, medical follow-up within 30 days and primary care engagement within 3 months increased by 4% between Year 1 and Year 3. Compared to Year 1, patients in Year 3 were 1.12 times more likely to have any medical follow-up (95% CI: 1.10, 1.13) and 1.13 times more likely to have a primary care visit (95% CI: 1.12, 1.15). Facilities with a greater proportion of patients receiving SIC had increased medical follow-up (RR: 1.04, 95% CI: 1.01, 1.07) and primary care engagement (RR: 1.06, 95% CI: 1.03, 1.10).
The VHA's SIC policy is associated with increased medical follow-up among patients initiating LTOT, which may result in improved patient safety and has implications for other healthcare settings.
为确保所有接受长期阿片类药物治疗（LTOT）的患者了解风险、益处及治疗替代方案，退伍军人健康管理局（VHA）于2014年发布了一项国家政策，以规范签署知情同意书（SIC）流程。我们评估了该政策对LTOT开始后医学随访的影响，这是一项指南推荐的做法。
利用VHA行政数据，我们确定了2013年5月至2016年5月期间开始接受LTOT的患者。我们采用中断时间序列设计，比较了三个时间段LTOT开始后30天内的每月医学随访率和3个月内的初级保健就诊率：政策发布前12个月（第1年）；政策发布后12个月（第2年）；以及政策发布后12 - 24个月，即SIC流程为强制性的时期（第3年）。
在经历758,416次LTOT开始的409,895名患者中，第1年和第3年之间，30天内的医学随访和3个月内的初级保健参与率提高了4%。与第1年相比，第3年的患者进行任何医学随访的可能性高1.12倍（95%置信区间：1.10, 1.13），进行初级保健就诊的可能性高1.13倍（95%置信区间：1.12, 1.15）。接受SIC的患者比例较高的机构，其医学随访（相对风险：1.04，95%置信区间：1.01, 1.07）和初级保健参与率（相对风险：1.06，95%置信区间：1.03, 1.10）有所增加。
VHA的SIC政策与开始接受LTOT的患者医学随访增加相关，这可能会提高患者安全性，并对其他医疗环境产生影响。
