Research Objective Veterans with opioid use disorder (OUD) are at significant risk of overdose, unintentional death, and a wide range of negative health‐related consequences. While evidenced‐based treatments for OUD exist, including medications for opioid use disorder (MOUD) like buprenorphine (suboxone), there are a number of barriers preventing veterans from accessing this care. A potential avenue to increase the numbers of veterans who can access high quality mental healthcare such as MOUD is through telemental healthcare using VA Video Connect (VVC). While telehealth can mitigate this access to care issue, the opioid crisis led to the Ryan Haight Act of 2008, which mandates that the first visit with a prescriber of schedule II‐IV controlled substances be conducted in person. However, due to the public health emergency caused by COVID‐19, the in person requirement for controlled substances is temporarily waived. Study Design The aims of this project were to examine temporal changes in controlled substances from September 2019 – August 2020 (6 months before and after the requirement was waived), to understand the impacts of this waiver for veterans with OUD. Population Studied We examined prescription information from the VA Corporate Data Warehouse for 42,579 Veterans diagnosed with OUD (91.6% male, 71% white, 16.8% black, 27% rural dwelling). Principal Findings During this 12‐month window, 56.6% of the sample were prescribed suboxone, 53.6% were prescribed sedatives, and 13.8% were prescribed anxiolytics. Monthly an average of 33,323 (SD = 3190) prescriptions were filled, with an average of 1.45 (SD = 0.08) medications prescribed per visit. As expected, the largest dip was seen in April 2020, with only 28,376 prescriptions filled, with an 1.33 prescriptions written per visit. As of August 2020, the rates for prescriptions for controlled substances had not returned to pre‐COVID levels. Conclusions These data suggest that while telehealth is a legal option to appropriately prescribe controlled substances, it was not utilized in a way that replicated in person care. Future projects that focus on understanding and addressing barriers providers face when attempting to provide care via telehealth are an important next step. Additionally, there was no dramatic increase in prescriptions for controlled substances as a result of the Ryan Haight waiver. Implications for Policy or Practice These data support keeping the wavier of in person appointments in the Ryan Haight Act is one useful avenue to help providers to provide access to life saving MOUDs. Primary Funding Source Department of Veterans Affairs.
High-quality care during and after a medication process requires complete and accurate medication administration documentation. Veterans Affairs Medical Centers use barcode medication administration technology to document medication administered to Veterans throughout the inpatient and long-term care areas of the hospital. Barcode medication administration has demonstrated a reduction in medication administration errors; however, it is not commonly used in Veterans Affairs Medical Center clinical areas or emergency departments. During this study, only 39% of the recorded 165 Veterans Affairs Medical Centers that use barcode medication administration technology in their inpatient areas stated that barcode medication administration was also used in clinical areas of the hospital. Of these facilities, only 14% had implemented barcode medication administration in their emergency department. This study evaluated medication error rates before and after barcode medication administration technology was implemented in the emergency department of a Veterans Affairs Medical Center located in the Southeastern region of the United States. A total of 258 charts, 129 before and 129 after barcode medication administration technology implementation in the emergency department, were reviewed for Veterans who were evaluated and ordered to receive medication in the emergency department before transferring to an inpatient unit at the Veterans Affairs Medical Center where this study was conducted. A quantitative nonexperimental descriptive comparison demonstrated a 10.8% reduction in medication error rates and 21% reduction in the average number of medications given in error per chart after barcode medication administration technology was implemented in the emergency department. In addition to the study outcome, a potentially unsafe workaround was identified. Stakeholders that use barcode medication administration technology in their emergency departments would benefit from assessing the association between barcode medication administration use and medication administration error rates. However, assessing whether barcode medication administration technology remains useful and continues to provide safe medication administration practices for our Veterans is also recommended.
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