Electronic Medical Record Alert Associated With Reduced Opioid and Benzodiazepine Coprescribing in High-risk Veteran Patients

Bibliographic Data

ID9104965
AuthorsCarol A Malte (0000-0002-6126-0733, Veterans Affairs (VA) Health Services Research & Development (HSR&D) Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, corresponding author), Douglas Berger (0000-0002-8568-9163, VA Puget Sound Health Care System), Andrew J Saxon (0000-0003-3880-2589, Veterans Affairs (VA) Health Services Research & Development (HSR&D) Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, corresponding author), Hildi J Hagedorn (Minneapolis VA Health Care System), Hildi Hagedorn (0000-0002-5118-7624, University of Minnesota), Carol E Achtmeyer (Veterans Affairs (VA) Health Services Research & Development (HSR&D) Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, corresponding author), Anthony J Mariano (VA Puget Sound Health Care System), Eric J Hawkins (0000-0001-5467-1553, Veterans Affairs (VA) Health Services Research & Development (HSR&D) Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, corresponding author)
Year2018
Volume56
Issue2
Pages171-178
Publication date2018-02-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000861
PMID29287034
OpenAlexW2976246739
LanguageEN
References cited33

BACKGROUND: Over the past decade, overdoses involving opioids and benzodiazepines have risen at alarming rates, making reductions in coprescribing of these medications a priority, particularly among patients who may be susceptible to adverse events due to high-risk conditions. OBJECTIVES: This quality improvement project evaluated the effectiveness of a medication alert designed to reduce opioid and benzodiazepine coprescribing among Veterans with known high-risk conditions (substance use, sleep apnea, suicide-risk, age 65 and above) at 1 Veterans Affairs (VA) health care system. METHODS: Prescribers were exposed to the point-of-prescribing alert for 12 months. For each high-risk cohort we used interrupted time series design to examine population trends in coprescribing 12 months after alert launch adjusting for coprescribing 12 months before launch, demographics and clinical covariates. Trends at the alert site were compared with those of a similar VA health care system without the alert. Secondary analyses examined population trends in opioid and benzodiazepine prescribing separately. RESULTS: Over 12 months, the alert activated for 1332 patients. Proportions of patients with concurrent prescriptions decreased significantly postalert launch among substance use [adjusted odds ratio (AOR)=0.97; 95% confidence interval (CI)=0.96-0.99; 12-month decrease=25.0%], sleep apnea (AOR=0.97, 95% CI=0.95-0.98, 12-month decrease=38.5%), and suicide-risk (AOR=0.94, 95% CI=0.91-0.98, 12-month decrease=61.5%) cohorts at the alert site. Decreases in coprescribing were significantly different from the comparison site among suicide-risk (AOR=0.92, 95% CI=0.86-0.97) and sleep apnea (AOR=0.98, 95% CI=0.96-1.00) cohorts. Significant decreases in benzodiazepine prescribing trends were observed at the alert site only. CONCLUSIONS: Medication alerts hold promise as a means of reducing opioid and benzodiazepine coprescribing among certain high-risk groups

Benzodiazepine · Confidence interval · Environmental health · Odds ratio · Population · Veterans Affairs · Emergency Medicine · Internal Medicine · Medicine · Opioid Use Disorder Treatment · Pain Management and Opioid Use · Sleep and related disorders