scholarly journals Opioid Discontinuation Among Patients Receiving High-Dose Long-Term Opioid Therapy in the Veterans Health Administration

2020 ◽  
Vol 35 (S3) ◽  
pp. 903-909
Author(s):  
Taeko Minegishi ◽  
Melissa M. Garrido ◽  
Michael Stein ◽  
Elizabeth M. Oliva ◽  
Austin B. Frakt
Keyword(s):  
Veterans Health Administration ◽  
Opioid Therapy ◽  
High Dose ◽  
Veterans Health ◽  
Health Administration

Classification of Patients for whom benefit no longer outweighs harm of long-term opioid therapy: Protocol for a Delphi study (Preprint)

2021 ◽  
Author(s):  
Raymond Van Cleve ◽  
Sara Edmond ◽  
Jennifer Snow ◽  
Anne Black ◽  
Jamie Pommeranz ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Delphi Study ◽  
Opioid Therapy ◽  
High Dose ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Dependency ◽  
Modified Delphi ◽  
Modified Delphi Technique

UNSTRUCTURED Introduction: Patients with chronic pain who have been prescribed long term opioid therapies often come to a point where the benefits of their therapy are out weighted by the risks associated with taking such a high dose of opioid medication. These patients need to taper off their opioid therapy while simultaneously treating their chronic pain. At the 2019 Veterans' Health Administration State of the Art Conference, there was an acknowledgment of a lack of clinical guidance with regards to treating this subset of patients. Some of the participants believed clinicians and patients would both benefit from a new diagnostic entity describing this situation where patients needed to have their opioid dependency and chronic pain simultaneously treated. Given the ability of a Delphi method to synthesize input from a broad range of experts, we felt this technique could be used to determine if a new diagnostic entity was needed and what the criteria of the diagnostic entity would be. Methods: This would be a modified Delphi technique involving three rounds. The first round would be a series of open ended questions asking about the necessity of this diagnostic entity, how this condition is different from OUD, and what it's possible diagnostic criteria would be. After synthesizing the responses collected, a second round would be conducted to ask participants to rate the different responses offered by their peers. These ratings would be collected, analyzed, and would generate a final potential definition for this clinical phenomena. In the third round we would circulate this definition and would hopefully gain consensus. Dissemination: This protocol has been approved by the Internal Review Board at the Connecticut VA and the study is in process. We hope that other researchers can use this protocol to conduct similar studies and further explore how patients with concurrent chronic pain and opioid dependency can be best served.

scholarly journals Survival and Causes of Death Among Veterans With Lower Extremity Revascularization With Paclitaxel‐Coated Devices: Insights From the Veterans Health Administration

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Jorge Antonio Gutierrez ◽  
Sunil V. Rao ◽  
William Schuyler Jones ◽  
Eric A. Secemsky ◽  
Aaron W. Aday ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Veterans Health Administration ◽  
Endovascular Intervention ◽  
Veterans Administration ◽  
Veterans Health ◽  
Coding System ◽  
Health Administration ◽  
Term Survival ◽  
All Cause Mortality

BACKGROUND The long‐term safety of paclitaxel‐coated devices (PCDs; drug‐coated balloon or drug‐eluting stent) for peripheral endovascular intervention is uncertain. We used data from the Veterans Health Administration to evaluate the association between PCDs, long‐term mortality, and cause of death. METHODS AND RESULTS Using the Veterans Administration Corporate Data Warehouse in conjunction with International Classification of Diseases, Tenth Revision ( ICD‐10 ) Procedure Coding System, Current Procedural Terminology, and Healthcare Common Procedure Coding System codes, we identified patients with peripheral artery disease treated within the Veterans Administration for femoropopliteal artery revascularization between October 1, 2015, and June 30, 2019. An adjusted Cox regression, using stabilized inverse probability–weighted estimates, was used to evaluate the association between PCDs and long‐term survival. Cause of death data were obtained using the National Death Index. In total, 10 505 patients underwent femoropopliteal peripheral endovascular intervention; 2265 (21.6%) with a PCD and 8240 (78.4%) with a non‐PCD (percutaneous angioplasty balloon and/or bare metal stent). Survival rates at 2 years (77.4% versus 79.7%) and 3 years (70.7% versus 71.8%) were similar between PCD and non‐PCD groups, respectively. The adjusted hazard for all‐cause mortality for patients treated with a PCD versus non‐PCD was 1.06 (95% CI, 0.95–1.18, P =0.3013). Among patients who died between October 1, 2015, and December 31, 2017, the cause of death according to treatment group, PCD versus non‐PCD, was similar. CONCLUSIONS Among patients undergoing femoropopliteal peripheral endovascular intervention within the Veterans Administration Health Administration, there was no increased risk of long‐term, all‐cause mortality associated with PCD use. Cause‐specific mortality rates were similar between treatment groups.

scholarly journals Regional and Rural–Urban Variation in Opioid Prescribing in the Veterans Health Administration

2019 ◽  
Vol 184 (11-12) ◽  
pp. 894-900 ◽  
Author(s):  
Brian C Lund ◽  
Michael E Ohl ◽  
Katherine Hadlandsmyth ◽  
Hilary J Mosher
Keyword(s):  
Rural Areas ◽  
Regional Variation ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Opioid Prescribing ◽  
Rural And Urban ◽  
Per Capita

Abstract Introduction Opioid prescribing is heterogenous across the US, where 3- to 5-fold variation has been observed across states or other geographical units. Residents of rural areas appear to be at greater risk for opioid misuse, mortality, and high-risk prescribing. The Veterans Health Administration (VHA) provides a unique setting for examining regional and rural–urban differences in opioid prescribing, as a complement and contrast to extant literature. The objective of this study was to characterize regional variation in opioid prescribing across Veterans Health Administration (VHA) and examine differences between rural and urban veterans. Materials and Methods Following IRB approval, this retrospective observational study used national administrative VHA data from 2016 to assess regional variation and rural–urban differences in schedule II opioid prescribing. The primary measure of opioid prescribing volume was morphine milligram equivalents (MME) dispensed per capita. Secondary measures included incidence, prevalence of any use, and prevalence of long-term use. Results Among 4,928,195 patients, national VHA per capita opioid utilization in 2016 was 1,038 MME. Utilization was lowest in the Northeast (894 MME), highest in the West (1,368 MME), and higher among rural (1,306 MME) than urban (988 MME) residents (p < 0.001). Most of the difference between rural and urban veterans (318 MME) was attributable to differences in long-term opioid use (312 MME), with similar rates of short-term use. Conclusion There is substantial regional and rural–urban variation in opioid prescribing in VHA. Rural veterans receive over 30% more opioids than their urban counterparts. Further research is needed to identify and address underlying causes of these differences, which could include access barriers for non-pharmacologic treatments for chronic pain.

scholarly journals Health Outcomes Among Long-term Opioid Users With Testosterone Prescription in the Veterans Health Administration

2019 ◽  
Vol 2 (12) ◽  
pp. e1917141 ◽  
Author(s):  
Guneet K. Jasuja ◽  
Omid Ameli ◽  
Joel I. Reisman ◽  
Adam J. Rose ◽  
Donald R. Miller ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Users

scholarly journals 989. Clinical Effectiveness of High-Dose Trivalent vs. Quadrivalent Influenza Vaccination Among Veterans Health Administration Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S292-S293
Author(s):  
Yinong Young-Xu ◽  
Ellyn Russo ◽  
Nabin Neupane ◽  
Melissa Lewis ◽  
Yuliya Halchenko
Keyword(s):  
Influenza Vaccination ◽  
Influenza Season ◽  
Standard Dose ◽  
Clinical Effectiveness ◽  
Veterans Health Administration ◽  
High Dose ◽  
Administrative Claims ◽  
Veterans Health ◽  
Health Administration ◽  
Influenza Pneumonia

Abstract Background Despite the widespread availability of several injectable inactivated influenza vaccines (IIV), including the trivalent standard-dose (IIV3-SD) and high-dose (IIV3-HD), and the quadrivalent (IIV4), the US Advisory Committee on Immunization Practices does not currently recommend one over another. The objective of this study was to assess the relative vaccine effectiveness (rVE) of IIV3-HD and IIV4 vs. IIV3-SD. Methods rVE was estimated from a retrospective cohort study of Veterans aged 65 years and older who received an IIV during the 2014–2015 influenza season. Veterans Health Administration (VHA) electronic medical records were linked with Centers for Medicare and Medicate Services administrative claims to capture the study outcomes of hospitalizations and baseline characteristics. The inverse probability of treatment weight (IPTW) method was used to adjust for potential confounding due to unmeasured factors associated with IIV3-SD, IIV3-HD, or IIV4 vaccination. The probability was estimated based on patient sociodemographic characteristics, comorbidities, pre-influenza season hospitalizations, prior season influenza vaccination, and use of immunosuppressive medication. Results Our study population included 782,346 VHA patients vaccinated during the 2014–2015 season. Of these, 10,543 (1%) received IIV4, while 59,536 (8%) received IIV3-HD and 712,267 (91%) received IIV3-SD. 11,626 (1.5%) were female and 588,324 (76%) were non-Hispanic white. Compared with those that received IIV3-SD vaccine, the IPTW-adjusted rVE for IIV3-HD was 7% (95% CI, 9%–21%) against all-cause, 15% (95% CI, 10%–17%) against cardiorespiratory associated, and 13% (95% CI, 8%–17%) against influenza/pneumonia-associated hospitalization. For those that received IIV4, the IPTW-adjusted rVE was 4% (95% CI, 1%–4%), 1% (95% CI, −2%–5%), and 0% (95% CI, −9%–8%), respectively. Conclusion IIV3-HD is more effective than, and IIV4 is as effective as, IIV3-SD vaccination in preventing influenza/pneumonia-associated, cardiorespiratory, and all-cause hospitalizations. Additional studies that employ methods to control for unmeasured confounding are warranted as the use of IIV4 expands. Disclosures All authors: No reported disclosures.

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