scholarly journals 212. Measuring the Morbidity of Infectious Complications of the Opiate Epidemic: A Retrospective Cohort Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S214-S214
Author(s):  
Leah Harvey ◽  
Hassen Abdulkerim ◽  
Jacqueline Boudreau ◽  
Judith Strymish ◽  
Justeen Hyde ◽  
...  
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Retrospective Cohort ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Optimal Strategies ◽  
Prior History ◽  
Veterans Health ◽  
Health Administration ◽  
History Of

Abstract Background Many states have reported that the incidence of invasive bacterial and viral infections has risen alongside rates of opiate use and injection drug use. The aim of this exploratory project is to characterize the incidence of invasive bacterial infections (IBI) over time in a national Veteran population, describe screening for substance use among Veterans with IBI, and assess engagement in harm reduction services. Methods A national, multicenter, retrospective cohort of Veterans admitted to the Veterans Health Administration (VA) between 10/1/2008 – 9/30/2018 with a positive blood culture was created using electronic health record (EHR) data. Patients’ demographics, clinical characteristics, microbiologic cultures, prescription history, laboratory values, and administrative coding data were extracted from the EHR. All analyses were performed in Microsoft Excel. Results Among 5,158,137 inpatient admissions during the study period, we identified 257,926 unique patients with bacteremia (5.0%). The incidence of bacteremia/sepsis increased consistently during the study period, rising from 2.29 per 10,000 patient-days to 5.97 per 10,000 patient-days across the national VA healthcare system (Figure 1). Among Veterans with bacteremia, 17,436 (6.8%) had prior history of substance use and 24,927 (9.7%) had a history of hepatitis C virus infection. In 196,295 cases (76.1%), no urine toxicology screening was completed or the result was negative. 34,005 (13.2%) of patients with bacteremia had at least one urinary toxicology positive for opiates and of these, 6,173 (18.1%) had documentation of a prescription for either naltrexone or buprenorphine/naloxone prior to admission or on hospital discharge. Conclusion Similar to findings in other populations, the incidence of IBI has steadily increased within the national VA. Despite limited screening, a high proportion of patients admitted to the VA with IBI were found to have underlying substance use. Additional work, including increased screening, is needed to assess the uptake of evidence-based interventions, such as naloxone, and to identify optimal strategies for improving adoption of other harm reduction services in this population. Disclosures All Authors: No reported disclosures

scholarly journals AGHE as an Incubator for Interdisciplinary Education

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 543-544
Author(s):  
Thomas Teasdale ◽  
Judith Howe ◽  
Carol Rogers
Keyword(s):  
Interprofessional Education ◽  
Training Programs ◽  
Health Resources ◽  
Veterans Health Administration ◽  
Interdisciplinary Education ◽  
Veterans Health ◽  
Health Administration ◽  
Federal Funds ◽  
Interprofessional Cooperation ◽  
History Of

Abstract For several decades, the history of interdisciplinary education and the development of AGHE initiatives have been closely linked. The need to educate colleagues on methods and benefits of interdisciplinary/ interprofessional cooperation toward service and research of aging has never waned. In this presentation we (a) highlight how AGHE has performed as a potent incubator for progress in this area and (b) use a few examples to illustrate how notable resulting efforts have improved geriatric care. For example, early and significant infusion of federal funds for gerontology training programs supported multi-disciplinary university-based centers, the Veterans Health Administration created interprofessional geriatric training programs, foundations such as John A. Hartford and Josiah Macy founded team training and interprofessional education programs, and the Health Resources and Services Administration funded Geriatric Education Centers and Geriatric Workforce Enhancement Programs. Efforts to advance interdisciplinary/interprofessional education have been fruitful and AGHE’s role as an incubator continues to evolve.

Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: a retrospective cohort study

2021 ◽  
pp. bmjqs-2020-012975
Author(s):  
Peter J Kaboli ◽  
Matthew R Augustine ◽  
Bjarni Haraldsson ◽  
Nicholas M Mohr ◽  
M Bryant Howren ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Suicide Risk ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Bed Occupancy ◽  
Increased Risk

BackgroundVeteran suicides have increased despite mental health investments by the Veterans Health Administration (VHA).ObjectiveTo examine relationships between suicide and acute inpatient psychiatric bed occupancy and other community, hospital and patient factors.MethodsRetrospective cohort study using administrative and publicly available data for contextual community factors. The study sample included all veterans enrolled in VHA primary care in 2011–2016 associated with 111 VHA hospitals with acute inpatient psychiatric units. Acute psychiatric bed occupancy, as a measure of access to care, was the main exposure of interest and was categorised by quarter as per cent occupied using thresholds of ≤85%, 85.1%–90%, 90.1%–95% and >95%. Hospital-level analyses were conducted using generalised linear mixed models with random intercepts for hospital, modelling number of suicides by quarter with a negative binomial distribution.ResultsFrom 2011 to 2016, the national incidence of suicide among enrolled veterans increased from 39.7 to 41.6 per 100 000 person-years. VHA psychiatric bed occupancy decreased from a mean of 68.2% (IQR 56.5%–82.2%) to 65.4% (IQR 53.9%–79.9%). VHA hospitals with the highest occupancy (>95%) in a quarter compared with ≤85% had an adjusted incident rate ratio (IRR) for suicide of 1.10 (95% CI 1.01 to 1.19); no increased risk was observed for 85.1%–90% (IRR 0.96; 95% CI 0.89 to 1.03) or 90.1%–95% (IRR 0.96; 95% CI 0.89 to 1.04) compared with ≤85% occupancy. Of hospital and community variables, suicide risk was not associated with number of VHA or non-VHA psychiatric beds or amount spent on community mental health. Suicide risk increased by age categories, seasons, geographic regions and over time.ConclusionsHigh VHA hospital occupancy (>95%) was associated with a 10% increased suicide risk for veterans whereas absolute number of beds was not, suggesting occupancy is an important access measure. Future work should clarify optimal bed occupancy to meet acute psychiatric needs and ensure adequate bed distribution.

Thyroid Hormone Therapy and Incident Stroke

2021 ◽  
Author(s):  
Maria Papaleontiou ◽  
Deborah A Levine ◽  
David Reyes-Gastelum ◽  
Sarah T Hawley ◽  
Mousumi Banerjee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Thyroid Hormone ◽  
Hormone Treatment ◽  
Population Based ◽  
Thyroid Stimulating Hormone ◽  
Prior History ◽  
Veterans Health ◽  
Health Administration ◽  
Free T4 ◽  
Increased Risk

Abstract Context Stroke is a leading cause of death and disability and there is a need to identify modifiable risk factors. Objective Determine the relationship between thyroid hormone treatment intensity and incidence of atrial fibrillation and stroke. Design Retrospective cohort study using data from the Veterans Health Administration between 2004 and 2017, with a median follow-up of 59 months. Setting Population-based. Participants 733,208 thyroid hormone users aged ≥18 years with at least two thyroid stimulating hormone (TSH) measurements between thyroid hormone initiation and incident event or study conclusion (406,030 thyroid hormone users with at least two free T4 measurements). Main Outcome Measures Incident atrial fibrillation and stroke. Results Overall, 71,333/643,687 (11.08%) participants developed incident atrial fibrillation and 41,931/663,809 (6.32%) stroke. In multivariable analyses controlling for pertinent factors such as age, sex and prior history of atrial fibrillation, low TSH or high free T4 levels (i.e., exogenous hyperthyroidism; e.g., TSH<0.1 mIU/L, OR 1.33, 95% CI 1.24-1.43) and high TSH or low free T4 levels (i.e., exogenous hypothyroidism; e.g., TSH>5.5 mIU/L, OR 1.29, 95% CI 1.26-1.33; free T4<0.7 ng/dL, OR 1.29, 95% CI 1.22-1.35) were associated with higher incidence of stroke compared to euthyroidism (TSH >0.5-5.5 mIU/L and free T4 0.7-1.9 ng/dL). Risk of developing atrial fibrillation and stroke was cumulative over time for both patients with exogenous hyperthyroidism and hypothyroidism. Conclusions Both exogenous hyper- and hypothyroidism were associated with increased risk of stroke, highlighting the importance of patient medication safety.

Assessing Readiness to Change of a High Fall Risk Patient: A Case Report

2012 ◽  
Vol 13 (1) ◽  
pp. 2-7
Author(s):  
Alexandra Lee ◽  
Julia Neily ◽  
Peter Mills ◽  
Cheryl Coutermarsh ◽  
Melissa Gates-Cantrell
Keyword(s):  
Case Report ◽  
Transtheoretical Model ◽  
Fall Risk ◽  
Readiness To Change ◽  
Risk Patient ◽  
Veterans Health ◽  
Health Administration ◽  
Home Based ◽  
Informal Interview ◽  
History Of

The case report discusses a patient with an extensive history of falls living in the community. The patient’s medical record was analyzed, and an informal interview was conducted with the patient to provide an overview of his care provided by the Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) program from June 2008 to February 2011. The report will also apply the transtheoretical model of behavioral change to discuss the behavior change process of a high fall risk patient. Applying this model to the high fall risk population may assist with decreasing the frustration of clinicians and caregivers, as it acknowledges the “smaller gains” with fall prevention.

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