J Am Pharm Assoc (2003). 2024 Nov-Dec;64(6):102250. doi: 10.1016/j.japh.2024.102250. Epub 2024 Sep 12.
Compared to the general population, Veterans Health Administration (VHA) patients have higher rates of mental illness, chronic pain, and substance use disorders (SUD), conditions that increase risk for opioid-related adverse events. VHA developed the Stratification Tool for Opioid Risk Mitigation (STORM) and mandated case reviews by an interdisciplinary team (IDT) for patients identified as very high risk, a process implemented and led by clinical pharmacist practitioners at the Orlando Veterans Affairs Healthcare System (OVAHCS) in 2018.
To evaluate and describe the implementation and process for IDT reviews of patients identified as very high risk by the STORM clinical decision support tool at OVAHCS.
A single center, retrospective, observational chart review was conducted. Veterans reviewed by the STORM IDT between January and September 2018 were reviewed for change in Morphine Equivalent Daily Dose (MEDD), naloxone, nonopioid analgesics, medications for SUD, benzodiazepines, engagement with clinical services (e.g., mental health, SUD, and pain clinic), and overdose or suicide attempts in the year prior versus the year after IDT review. The frequency of follow-up IDT reviews was evaluated.
Seventeen patients were identified. Four were excluded due to nonopioid related death within 12 months after review. The average baseline MEDD was 82.2 mg (range 10-496 mg) and average 12 months after review was 7.5 mg (range 0 - 67.5 mg), a decrease of 74.7 mg, or 90.9% reduction. An increase in medications for SUD (3 patients; 23%), SUD engagement (3 to 6 patients), and urine drug tests was observed (79% increase). Benzodiazepine use decreased by 50%.
This report provides insight on the IDT case review process at OVAHCS, a process that may vary widely across facilities. A reduction in MEDD, increase in SUD treatment, and improved risk mitigation was observed. The central role of clinical pharmacy and expanded process for continued follow-up warrants further study.
与普通人群相比，退伍军人健康管理局 (VHA) 的患者精神疾病、慢性疼痛和物质使用障碍 (SUD) 的发病率更高，这些疾病会增加阿片类药物相关不良事件的风险。VHA 开发了分层工具来减轻阿片类药物风险 (STORM)，并要求跨学科团队 (IDT) 对被确定为极高风险的患者进行病例审查，这一过程由临床药师从业者在 2018 年在奥兰多退伍军人事务医疗保健系统 (OVAHCS) 实施和领导。
评估和描述 OVAHCS 中使用 STORM 临床决策支持工具识别为极高风险的患者进行 IDT 审查的实施和流程。
进行了一项单中心、回顾性、观察性图表审查。对 2018 年 1 月至 9 月期间接受 STORM IDT 审查的退伍军人进行了审查，以评估 Morphine Equivalent Daily Dose (MEDD)、纳洛酮、非阿片类镇痛药、物质使用障碍药物、苯二氮䓬类药物、与临床服务（例如，心理健康、物质使用障碍和疼痛诊所）的参与度以及 IDT 审查前一年与后一年的药物过量或自杀企图的变化。评估了随访 IDT 审查的频率。
确定了 17 名患者。由于审查后 12 个月内非阿片类相关死亡，有 4 名患者被排除在外。平均基线 MEDD 为 82.2 毫克（范围 10-496 毫克），平均 12 个月后为 7.5 毫克（范围 0-67.5 毫克），减少了 74.7 毫克，即 90.9%减少。观察到物质使用障碍药物增加（3 名患者；23%）、物质使用障碍治疗参与度增加（3 至 6 名患者）和尿液药物检测增加（增加 79%）。苯二氮䓬类药物的使用减少了 50%。
本报告提供了 OVAHCS 跨学科团队病例审查流程的见解，该流程在不同设施之间可能有很大差异。观察到 MEDD 减少、物质使用障碍治疗增加和风险降低。临床药学的核心作用和持续跟进的扩展流程值得进一步研究。
