Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
Subst Use Addctn J. 2024 Oct;45(4):610-623. doi: 10.1177/29767342241243309. Epub 2024 Apr 18.
The Veterans Health Administration (VA) implemented academic detailing (AD) to support safer opioid prescribing and overdose prevention initiatives.
Patient-level data were extracted monthly from VA's electronic health record to evaluate whether AD implementation was associated with changes in all-cause mortality, opioid poisoning inpatient admissions, and opioid poisoning emergency department (ED) visits in an observational cohort of patients with long-term opioid prescriptions (≥45-day supply of opioids 6 months prior to a given month with ≤15 days between prescriptions). A single-group interrupted time series analysis using segmented logistic regression for mortality and Poisson regression for counts of inpatient admissions and ED visits was used to identify whether the level and slope of these outcomes changed in response to AD implementation.
Among 955 376 unique patients (19 431 241 person-months), there were 53 369 deaths (29 025 pre-AD; 24 344 post-AD), 1927 opioid poisoning inpatient admissions (610 pre-AD; 1317 post-AD), and 408 opioid poisoning ED visits (207 pre-AD; 201 post-AD). Immediately after AD implementation, there was a 5.8% reduction in the odds of all-cause mortality (95% confidence interval [CI]: 0.897, 0.990). However, patients had a significantly increased incidence rate of inpatient admissions for opioid poisoning immediately after AD implementation (incidence rate ratio = 1.523; 95% CI: 1.118, 2.077). No significant differences in ED visits for opioid poisoning were observed.
AD was associated with decreased all-cause mortality but increased inpatient hospitalization for opioid poisoning among patients prescribed long-term opioids. Mechanisms via which AD's efforts influenced opioid-related outcomes should be explored.
退伍军人事务部（VA）实施了学术细节（AD），以支持更安全的阿片类药物处方和预防过量用药计划。
从 VA 的电子健康记录中每月提取患者层面的数据，以评估 AD 的实施是否与以下结果的变化相关：全因死亡率、阿片类药物中毒住院入院和阿片类药物中毒急诊部（ED）就诊。在一个有长期阿片类药物处方（≥45 天的阿片类药物供应，在给定月份前 6 个月内处方之间的时间≤15 天）的患者观察队列中，使用分段逻辑回归进行死亡率的单组中断时间序列分析和泊松回归用于计数住院入院和 ED 就诊，以确定这些结果的水平和斜率是否因 AD 的实施而发生变化。
在 955376 名独特患者（19431241 人月）中，有 53369 人死亡（29025 人在 AD 前；24344 人在 AD 后），1927 人因阿片类药物中毒住院入院（610 人在 AD 前；1317 人在 AD 后），408 人因阿片类药物中毒 ED 就诊（207 人在 AD 前；201 人在 AD 后）。AD 实施后，全因死亡率的几率降低了 5.8%（95%置信区间[CI]：0.897，0.990）。然而，AD 实施后，阿片类药物中毒住院入院的发生率显著增加（发病率比=1.523；95%CI：1.118，2.077）。未观察到阿片类药物中毒 ED 就诊的显著差异。
AD 与长期服用阿片类药物的患者的全因死亡率降低有关，但与阿片类药物中毒住院率增加有关。应探索 AD 的努力影响阿片类药物相关结果的机制。
