Guideline-Concordant Management of Opioid Therapy Among Human Immunodeficiency Virus (HIV)-Infected and Uninfected Veterans

JOURNAL OF PAIN

卷:15

Article

Gaither, Julie R.¹  Goulet, Joseph L.^3,5  Becker, William C.^4,5  Crystal, Stephen⁶  Edelman, E. Jennifer^2,4  Gordon, Kirsha⁵  Kerns, Robert D.^3,5  Rimland, David^7,8  Skanderson, Melissa⁹  Weisberg, Daniel F.⁴  Justice, Amy C.^1,2,4,5  Fiellin, David A.^1,2,4 

[1] Yale Univ, Sch Publ Hlth, New Haven, CT 06520 USA

[2] Yale Univ, Sch Publ Hlth, Yale Ctr Interdisciplinary Res AIDS, New Haven, CT 06520 USA

[3] Yale Univ, Sch Med, Dept Psychiat, New Haven, CT 06520 USA

[4] Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06520 USA

[5] VA Connecticut Healthcare Syst, West Haven, CT USA

[6] Rutgers State Univ, Inst Hlth Hlth Care Policy & Aging Res, New Brunswick, NJ 08903 USA

[7] Emory Univ, Sch Med, Div Infect Dis, Atlanta, GA USA

[8] Atlanta VA Med Ctr, Decatur, GA USA

[9] VA Pittsburgh Healthcare Syst, Pittsburgh, PA USA

关键词: Opioid analgesics;    practice guideline;    quality of health care;    chronic pain;    HIV;   

DOI  :  10.1016/j.jpain.2014.08.004

来源: Elsevier

【 摘 要 】

Whether patients receive guideline-concordant opioid therapy (OT) is largely unknown and may vary based on provider and patient characteristics. We assessed the extent to which human immunodeficiency virus (HIV)-infected and uninfected patients initiating long-term (>= 90 days) OT received care concordant with American Pain Society/American Academy of Pain Medicine and Department of Veterans Affairs/Department of Defense guidelines by measuring receipt of 17 indicators during the first 6 months of OT. Of 20,753 patients, HIV-infected patients (n = 6,604) were more likely than uninfected patients to receive a primary care provider visit within 1 month (52.0% vs 30.9%) and 6 months (90.7% vs 73.7%) and urine drug tests within 1 month (14.8% vs 11.5%) and 6 months (19.5% vs 15.4%; all P < .001). HIV-infected patients were also more likely to receive OT concurrent with sedatives (24.6% vs 19.6%) and a current substance use disorder (21.6% vs 17.2%). Among both patient groups, only modest changes in guideline concordance were observed over time: urine drug tests and OT concurrent with current substance use disorders increased, whereas sedative coprescriptions decreased (all Ps for trend <.001). Over a 10-year period, on average, patients received no more than 40% of recommended care. OT guideline-concordant care is rare in primary care, varies by patient/provider characteristics, and has undergone few changes over time. Perspective: The promulgation of OT clinical guidelines has not resulted in substantive changes over time in OT management, which falls well short of the standard recommended by leading medical societies. Strategies are needed to increase the provision of OT guideline-concordant care for all patients. (C) 2014 by the American Pain Society. Published by Elsevier Inc. All rights reserved

【 授权许可】

Free