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1.
Ann Pharmacother ; 52(4): 325-331, 2018 04.
Article in English | MEDLINE | ID: mdl-29086587

ABSTRACT

BACKGROUND: Chronic opioid therapy-clinical reminder (COT-CR) is a decision support tool to prompt providers to carefully assess patients prescribed chronic opioids. This tool was developed to address inappropriate opioid prescribing. OBJECTIVE: To determine COT-CR's impact on reducing morphine equivalent monthly dose (MEMD) and risk index for overdose or serious prescription opioid-induced respiratory depression (RIOSORD) values in veterans receiving chronic opioids. METHODS: This retrospective cohort review matched patients with a complete COT-CR to patients with an incomplete COT-CR using propensity scores. In the primary aim, an interrupted time series design evaluated for changes in MEMD 12 months before and 6 months after the index date. The index date was the first pain or primary care provider visit post COT-CR installation. In the secondary aims, a retrospective cohort design was used to evaluate the changes in RIOSORD index score and risk class 6 months after the index date. RESULTS: After matching, 3801 patients were included in the complete and incomplete COT-CR groups, respectively. Greater average reduction in MEMD (-11.6 MEMD; 95% CI = -0.97 to -22.25 MEMD; P = 0.032) and RIOSORD index score (-0.53 RIOSORD index score; 95% CI = -1.00, -0.05 RIOSORD index score; P = 0.030) was observed in patients with a complete COT-CR compared to patients with an incomplete COT-CR. Differences in RIOSORD risk class were insignificant. CONCLUSION: Completing the COT-CR was associated with reduced MEMD and RIOSORD values. This suggests that active monitoring can change prescribing patterns, thereby, reducing the overall risk of opioid overdose in at-risk veterans.


Subject(s)
Analgesics, Opioid/administration & dosage , Decision Support Systems, Clinical , Pain/drug therapy , Practice Patterns, Physicians' , Aged , Analgesics, Opioid/therapeutic use , Drug Overdose/prevention & control , Female , Humans , Inappropriate Prescribing/prevention & control , Male , Middle Aged , Propensity Score , Respiratory Insufficiency/prevention & control , Retrospective Studies , Veterans
2.
Am J Health Syst Pharm ; 74(18): 1447-1459, 2017 Sep 15.
Article in English | MEDLINE | ID: mdl-28887346

ABSTRACT

PURPOSE: The process and operational elements to establish a population health program using electronic medical record data in a Veterans Health Administration region are described. SUMMARY: Pharmacists are uniquely qualified to assume important roles in population health through the use of their clinical knowledge, assisted by electronic tools that consolidate and report patient-specific data for clinical care. Veterans Integrated Services Network (VISN) 21 has developed 300 dashboards and reports to improve the quality, safety, and value of healthcare to veterans. Within a group of specialty task forces, physicians, nurses, and pharmacists assist in the design and development of evidence-based tools to leverage timely electronic health information into metrics, benchmarks, and targets to assist with goal achievement. Examples of programs designed to improve care in 3 areas were selected for further description and review of outcomes. Population health improvement using Healthcare Effectiveness Data and Information Set and hepatitis C metrics were used to describe populations that may have an indication for evidence-based care but are not receiving it. Deprescribing efforts are described, as are medication safety monitoring efforts to prevent potential adverse events known to be associated with therapy. CONCLUSION: Quality, safety, and value outcomes are the measures of success for population health programs in VISN 21. Data-rich project dashboards and reports are developed by pharmacist data analysts and implemented and used by teams of clinicians who provide continuous feedback and support to improve population health. The use of task forces, metrics, benchmarks, targets, and teams is instrumental in the successful application of these tools.


Subject(s)
Electronic Health Records/standards , Medication Therapy Management/standards , Pharmacists/standards , Population Health Management , United States Department of Veterans Affairs/standards , Veterans Health/standards , Advisory Committees/standards , Advisory Committees/trends , Data Analysis , Electronic Health Records/trends , Humans , Medication Therapy Management/trends , Pharmacists/trends , Pharmacy Service, Hospital/standards , Pharmacy Service, Hospital/trends , United States/epidemiology , United States Department of Veterans Affairs/trends , Veterans , Veterans Health/trends
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