Comilla Sasson1, Jason Smith2, Chad Kessler3, Jason Haukoos4, Julianne Himstreet5, Melissa Christopher6, Thomas Emmendorfer7. 1. Eastern Colorado Healthcare System, Veterans Health Administration, University of Colorado School of Medicine, Colorado School of Public Health, Aurora, CO, United States of America. Electronic address: comilla.sasson@ucdenver.edu. 2. National Academic Detailing Services, Veterans Health Administration, United States of America. Electronic address: Jason.Smith2@va.gov. 3. National Office of Emergency Medicine, Veterans Health Administration, United States of America. Electronic address: Chad.Kessler@va.gov. 4. Department of Emergency Medicine, Denver Health, Department of Emergency Medicine, University of Colorado School of Medicine, Department of Epidemiology, Colorado School of Public Health, Denver, CO, United States of America. Electronic address: Jason.Haukoos@dhha.org. 5. National Academic Detailing Services, Veterans Health Administration, United States of America. Electronic address: Julianne.Himstreet2@va.gov. 6. Pharmacy Benefits Management National Academic Detailing Services, Veterans Health Administration, United States of America. Electronic address: Melissa.Christopher@va.gov. 7. National Pharmacy Benefits Management, Veterans Health Administration, United States of America. Electronic address: Thomas.Emmendorfer@va.gov.
Abstract
OBJECTIVE: The Veterans Health Administration (VHA) is the largest integrated health care system in the U.S., serving approximately 2.5 million Veterans in the Emergency Department/Urgent Care Centers (ED/UCC) each year. Variation in opioid prescribing by ED/UCC providers in the VHA is described. METHODS: This is an observational study using administrative data from the VHA Pharmacy Benefits Management Services database to assess ED/UCC providers' opioid prescribing rates between October 1st, 2014 to June 30th, 2017 in 121 U.S. facilities. The opioid prescribing rate was defined as the number of opioid prescriptions written by the provider divided by the number of patients discharged from the ED/UCC by that provider, by quarter. A regression analysis was performed to estimate the association between time and prescribing rates by provider. RESULTS: Overall, the national trend in median prescribing rates decreased by 25.5% (p value = 0.00) from 9.1% ([range 1.5%-25.6%] to 6.4% [range 0.8%-21.8%]). The greatest rates of decline occurred between January 1st, 2016 to June 30th, 2017. The rate of provider opioid prescribing demonstrated wide variability between facilities (range: 0.5% to 39.1%). The prescribing rate for ED/UCC providers ranged from 0.2% to 100%. Between June 2016 and May 2017, 24 VHA ED/UCC providers were the highest opioid prescribers nationally in at least two of the four quarters (22%-70%), with rates two- to three-fold higher than their peers. CONCLUSION: ED/UCC providers in the VHA system nationally vary considerably in rates of opioid prescribing. A focused initiative tailored for ED/UCC providers is needed to decrease opioid prescribing variability. Published by Elsevier Inc.
OBJECTIVE: The Veterans Health Administration (VHA) is the largest integrated health care system in the U.S., serving approximately 2.5 million Veterans in the Emergency Department/Urgent Care Centers (ED/UCC) each year. Variation in opioid prescribing by ED/UCC providers in the VHA is described. METHODS: This is an observational study using administrative data from the VHA Pharmacy Benefits Management Services database to assess ED/UCC providers' opioid prescribing rates between October 1st, 2014 to June 30th, 2017 in 121 U.S. facilities. The opioid prescribing rate was defined as the number of opioid prescriptions written by the provider divided by the number of patients discharged from the ED/UCC by that provider, by quarter. A regression analysis was performed to estimate the association between time and prescribing rates by provider. RESULTS: Overall, the national trend in median prescribing rates decreased by 25.5% (p value = 0.00) from 9.1% ([range 1.5%-25.6%] to 6.4% [range 0.8%-21.8%]). The greatest rates of decline occurred between January 1st, 2016 to June 30th, 2017. The rate of provider opioid prescribing demonstrated wide variability between facilities (range: 0.5% to 39.1%). The prescribing rate for ED/UCC providers ranged from 0.2% to 100%. Between June 2016 and May 2017, 24 VHA ED/UCC providers were the highest opioid prescribers nationally in at least two of the four quarters (22%-70%), with rates two- to three-fold higher than their peers. CONCLUSION: ED/UCC providers in the VHA system nationally vary considerably in rates of opioid prescribing. A focused initiative tailored for ED/UCC providers is needed to decrease opioid prescribing variability. Published by Elsevier Inc.
Authors: Anna E Wentz; Ralph R C Wang; Brandon D L Marshall; Theresa I Shireman; Tao Liu; Roland C Merchant Journal: Am J Emerg Med Date: 2020-07-10 Impact factor: 2.469