Opioid use and opioid use disorder in mono and dual-system users of veteran affairs medical centers
IntroductionEfforts to achieve opioid guideline concordant care may be undermined when patients access multiple opioid prescription sources. Limited data are available on the impact of dual-system sources of care on receipt of opioid medications.ObjectiveWe examined whether dual-system use was assoc...
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| Format: | Article |
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1148189/full |
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| author | Joseph Goulet Joseph Goulet Yan Cheng Yan Cheng William Becker William Becker Cynthia Brandt Cynthia Brandt Friedhelm Sandbrink Terri Elizabeth Workman Terri Elizabeth Workman Phillip Ma Phillip Ma Alexander Libin Alexander Libin Alexander Libin Nawar Shara Nawar Shara Nawar Shara Christopher Spevak Christopher Spevak Joel Kupersmith Qing Zeng-Treitler Qing Zeng-Treitler |
| author_facet | Joseph Goulet Joseph Goulet Yan Cheng Yan Cheng William Becker William Becker Cynthia Brandt Cynthia Brandt Friedhelm Sandbrink Terri Elizabeth Workman Terri Elizabeth Workman Phillip Ma Phillip Ma Alexander Libin Alexander Libin Alexander Libin Nawar Shara Nawar Shara Nawar Shara Christopher Spevak Christopher Spevak Joel Kupersmith Qing Zeng-Treitler Qing Zeng-Treitler |
| author_sort | Joseph Goulet |
| collection | DOAJ |
| description | IntroductionEfforts to achieve opioid guideline concordant care may be undermined when patients access multiple opioid prescription sources. Limited data are available on the impact of dual-system sources of care on receipt of opioid medications.ObjectiveWe examined whether dual-system use was associated with increased rates of new opioid prescriptions, continued opioid prescriptions and diagnoses of opioid use disorder (OUD). We hypothesized that dual-system use would be associated with increased odds for each outcome.MethodsThis retrospective cohort study was conducted using Veterans Administration (VA) data from two facilities from 2015 to 2019, and included active patients, defined as Veterans who had at least one encounter in a calendar year (2015–2019). Dual-system use was defined as receipt of VA care as well as VA payment for community care (non-VA) services. Mono users were defined as those who only received VA services. There were 77,225 dual-system users, and 442,824 mono users. Outcomes were three binary measures: new opioid prescription, continued opioid prescription (i.e., received an additional opioid prescription), and OUD diagnosis (during the calendar year). We conducted a multivariate logistic regression accounting for the repeated observations on patient and intra-class correlations within patients.ResultsDual-system users were significantly younger than mono users, more likely to be women, and less likely to report white race. In adjusted models, dual-system users were significantly more likely to receive a new opioid prescription during the observation period [Odds ratio (OR) = 1.85, 95% confidence interval (CI) 1.76–1.93], continue prescriptions (OR = 1.24, CI 1.22–1.27), and to receive an OUD diagnosis (OR = 1.20, CI 1.14–1.27).DiscussionThe prevalence of opioid prescriptions has been declining in the US healthcare systems including VA, yet the prevalence of OUD has not been declining at the same rate. One potential problem is that detailed notes from non-VA visits are not immediately available to VA clinicians, and information about VA care is not readily available to non-VA sources. One implication of our findings is that better health system coordination is needed. Even though care was paid for by the VA and presumably closely monitored, dual-system users were more likely to have new and continued opioid prescriptions. |
| first_indexed | 2024-04-09T17:58:08Z |
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| id | doaj.art-8db5e1fdf1fe4df8a6aeb9df80b15106 |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-04-09T17:58:08Z |
| publishDate | 2023-04-01 |
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| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-8db5e1fdf1fe4df8a6aeb9df80b151062023-04-14T11:16:45ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-04-011110.3389/fpubh.2023.11481891148189Opioid use and opioid use disorder in mono and dual-system users of veteran affairs medical centersJoseph Goulet0Joseph Goulet1Yan Cheng2Yan Cheng3William Becker4William Becker5Cynthia Brandt6Cynthia Brandt7Friedhelm Sandbrink8Terri Elizabeth Workman9Terri Elizabeth Workman10Phillip Ma11Phillip Ma12Alexander Libin13Alexander Libin14Alexander Libin15Nawar Shara16Nawar Shara17Nawar Shara18Christopher Spevak19Christopher Spevak20Joel Kupersmith21Qing Zeng-Treitler22Qing Zeng-Treitler23VA Connecticut Healthcare System, West Haven, CT, United StatesYale School of Medicine, New Haven, CT, United StatesWashington DC VA Medical Center, Washington, DC, United StatesBiomedical Informatics Center, George Washington University, Washington, DC, United StatesVA Connecticut Healthcare System, West Haven, CT, United StatesYale School of Medicine, New Haven, CT, United StatesVA Connecticut Healthcare System, West Haven, CT, United StatesYale School of Medicine, New Haven, CT, United StatesWashington DC VA Medical Center, Washington, DC, United StatesWashington DC VA Medical Center, Washington, DC, United StatesBiomedical Informatics Center, George Washington University, Washington, DC, United StatesWashington DC VA Medical Center, Washington, DC, United StatesBiomedical Informatics Center, George Washington University, Washington, DC, United StatesMedStar Health, Washington, DC, United StatesGeorgetown University School of Medicine, Washington, DC, United StatesGeorgetown Howard Universities Center for Clinical and Translational Science, Washington, DC, United StatesMedStar Health, Washington, DC, United StatesGeorgetown University School of Medicine, Washington, DC, United StatesGeorgetown Howard Universities Center for Clinical and Translational Science, Washington, DC, United StatesGeorgetown University School of Medicine, Washington, DC, United StatesGeorgetown Howard Universities Center for Clinical and Translational Science, Washington, DC, United StatesGeorgetown University School of Medicine, Washington, DC, United StatesWashington DC VA Medical Center, Washington, DC, United StatesBiomedical Informatics Center, George Washington University, Washington, DC, United StatesIntroductionEfforts to achieve opioid guideline concordant care may be undermined when patients access multiple opioid prescription sources. Limited data are available on the impact of dual-system sources of care on receipt of opioid medications.ObjectiveWe examined whether dual-system use was associated with increased rates of new opioid prescriptions, continued opioid prescriptions and diagnoses of opioid use disorder (OUD). We hypothesized that dual-system use would be associated with increased odds for each outcome.MethodsThis retrospective cohort study was conducted using Veterans Administration (VA) data from two facilities from 2015 to 2019, and included active patients, defined as Veterans who had at least one encounter in a calendar year (2015–2019). Dual-system use was defined as receipt of VA care as well as VA payment for community care (non-VA) services. Mono users were defined as those who only received VA services. There were 77,225 dual-system users, and 442,824 mono users. Outcomes were three binary measures: new opioid prescription, continued opioid prescription (i.e., received an additional opioid prescription), and OUD diagnosis (during the calendar year). We conducted a multivariate logistic regression accounting for the repeated observations on patient and intra-class correlations within patients.ResultsDual-system users were significantly younger than mono users, more likely to be women, and less likely to report white race. In adjusted models, dual-system users were significantly more likely to receive a new opioid prescription during the observation period [Odds ratio (OR) = 1.85, 95% confidence interval (CI) 1.76–1.93], continue prescriptions (OR = 1.24, CI 1.22–1.27), and to receive an OUD diagnosis (OR = 1.20, CI 1.14–1.27).DiscussionThe prevalence of opioid prescriptions has been declining in the US healthcare systems including VA, yet the prevalence of OUD has not been declining at the same rate. One potential problem is that detailed notes from non-VA visits are not immediately available to VA clinicians, and information about VA care is not readily available to non-VA sources. One implication of our findings is that better health system coordination is needed. Even though care was paid for by the VA and presumably closely monitored, dual-system users were more likely to have new and continued opioid prescriptions.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1148189/fullopioidopioid-related disordersveteranslogistic modelsobservational study |
| spellingShingle | Joseph Goulet Joseph Goulet Yan Cheng Yan Cheng William Becker William Becker Cynthia Brandt Cynthia Brandt Friedhelm Sandbrink Terri Elizabeth Workman Terri Elizabeth Workman Phillip Ma Phillip Ma Alexander Libin Alexander Libin Alexander Libin Nawar Shara Nawar Shara Nawar Shara Christopher Spevak Christopher Spevak Joel Kupersmith Qing Zeng-Treitler Qing Zeng-Treitler Opioid use and opioid use disorder in mono and dual-system users of veteran affairs medical centers Frontiers in Public Health opioid opioid-related disorders veterans logistic models observational study |
| title | Opioid use and opioid use disorder in mono and dual-system users of veteran affairs medical centers |
| title_full | Opioid use and opioid use disorder in mono and dual-system users of veteran affairs medical centers |
| title_fullStr | Opioid use and opioid use disorder in mono and dual-system users of veteran affairs medical centers |
| title_full_unstemmed | Opioid use and opioid use disorder in mono and dual-system users of veteran affairs medical centers |
| title_short | Opioid use and opioid use disorder in mono and dual-system users of veteran affairs medical centers |
| title_sort | opioid use and opioid use disorder in mono and dual system users of veteran affairs medical centers |
| topic | opioid opioid-related disorders veterans logistic models observational study |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1148189/full |
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