A Research Agenda for Advancing Strategies to Improve Opioid Safety: Findings from a VHA State of the Art Conference

Becker, William C.; Krebs, Erin E.; Edmond, Sara N.; Lin, Lewei Allison; Sullivan, Mark D.; Weiss, Roger D.; Gordon, Adam J.

doi:10.1007/s11606-020-06260-9

Cited by 14 publications

(12 citation statements)

References 42 publications

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“…State-of-the-art participants represented a diverse array of professional backgrounds, including primary care, psychology, addiction medicine, addiction psychiatry, nursing, pharmacy, pain medicine, neurology, clinical epidemiology, health services research, and health policy. 5 This study was deemed exempt from human subjects committee review by the Veterans Affairs (VA) Connecticut Healthcare System Institutional Review Board; additional protocol details were published separately. 32…”

Section: Methodsmentioning

confidence: 99%

Delphi study to explore a new diagnosis for “ineffective” long-term opioid therapy for chronic pain

Edmond¹,

Snow²,

Pomeranz³

et al. 2022

Pain

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Section: Methodsmentioning

confidence: 99%

Delphi study to explore a new diagnosis for “ineffective” long-term opioid therapy for chronic pain

Edmond¹,

Snow²,

Pomeranz³

et al. 2022

Pain

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Section: Background and Objectivesmentioning

confidence: 99%

“…The VHA has a long history of supporting MOUD such that today more than 40% of patients seen in the VHA with OUD receive MOUD 28,31–34 . Considering that VHA clinicians are expected to offer MOUD to all patients with OUD and the relative lack of potential geographic and insurance barriers to access care, the VHA is an ideal setting to examine the provision of B‐MOUD training and practice 34 . Expanding upon our prior research, we sought to determine whether VHA clinicians who voluntarily attended an in‐person x‐waiver training as part of two larger initiatives to promote MOUD obtained an x‐waiver and reported prescribing B‐MOUD, while also examining barriers and facilitators to the provision of B‐MOUD for prescribers and non‐prescribers alike 29 …”

Section: Background and Objectivesmentioning

confidence: 99%

Are x‐waiver trainings enough? Facilitators and barriers to buprenorphine prescribing after x‐waiver trainings

et al. 2022

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Background In the United States, an x‐waiver credential is necessary to prescribe buprenorphine medication treatment for opioid use disorder (B‐MOUD). Historically, this process has required certified training, which could be a barrier to obtaining an x‐waiver and subsequently prescribing. To address this barrier, the US recently removed the training requirement for some clinicians. We sought to determine if clinicians who attended x‐waiver training went on to obtain an x‐waiver and prescribe B‐MOUD, and to examine what facilitated or impeded B‐MOUD prescribing. Methods In September 2020, we conducted a cross‐sectional, electronic survey of attendees of 15 in‐person x‐waiver pieces of training from June 2018 to January 2020 within the Veterans Health Administration (VHA). Of the attendees (n = 321), we surveyed current VHA clinicians who recalled taking the training. The survey assessed whether clinicians obtained the x‐waiver, had prescribed B‐MOUD, and barriers or facilitators that influenced B‐MOUD prescribing. Results Of 251 eligible participants, 62 (24.7%) responded to the survey, including 27 (43.5%) physicians, 16 (25.8%) advanced practice clinicians, and 12 (19.4%) pharmacists. Of the 43 clinicians who could prescribe, 29 (67.4%) had obtained their x‐waiver and 16 (37.2%) had reported prescribing B‐MOUD. Prominent barriers to prescribing B‐MOUD included a lack of supporting clinical staff and competing demands on time. The primary facilitator to prescribing was leadership support. Conclusion and Scientific Significance Nine months after x‐waiver training, two‐thirds of clinicians with prescribing credentials had obtained their x‐waiver and one‐third were prescribing B‐MOUD. Removing the x‐waiver training may not have the intended policy effect as other barriers to B‐MOUD prescribing persist.

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“…These experts believe concurrent opioid dependence and chronic pain are more than the sum of their parts, and a new diagnostic entity could address this complexity [ 10 ], something clinicians and researchers have struggled with in using the OUD diagnosis on its own. During the 2019 Veterans Health Administration (VHA) Health Services Research and Development (HSR&D) State of the Art (SOTA) Conference, consensus emerged on the need for a Delphi study to understand if a new diagnostic entity is needed and, if so, to develop consensus on its criteria and characteristics [ 11 ]. The modified Delphi method is designed to gain consensus on a discrete topic that does not yet have a clear definition [ 12 ] and has been used in previous studies concerning OUD.…”

Section: Introductionmentioning

confidence: 99%

Classification of Patients for Whom Benefit of Long-term Opioid Therapy No Longer Outweighs Harm: Protocol for a Delphi Study

Cleve¹,

Edmond²,

Snow³

et al. 2022

JMIR Res Protoc

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Background Patients with chronic pain prescribed long-term opioid therapy may come to a point where the benefits of the therapy are outweighed by the risks and tapering is indicated. At the 2019 Veterans Health Administration State of the Art Conference, there was an acknowledgment of a lack of clinical guidance with regard to treating this subset of patients. Some of the participants believed clinicians and patients would both benefit from a new diagnostic entity describing this situation. Objective The aim of this study was to determine if a new diagnostic entity was needed and what the criteria of the diagnostic entity would be. Given the ability of the Delphi method to synthesize input from a broad range of experts, we felt this technique was the most appropriate for this study. Methods We designed a modified Delphi technique involving 3 rounds. The first round is a series of open-ended questions asking about the necessity of this diagnostic entity, how this condition is different from opioid use disorder, and what its possible diagnostic criteria would be. After synthesizing the responses collected, a second round will be conducted to ask participants to rate the different responses offered by their peers. These ratings will be collected and analyzed, and will generate a preliminary definition for this clinical phenomena. In the third round, we will circulate this definition with the aim of achieving consensus. Results The modified Delphi study was initiated in July of 2020 and analysis is currently underway. Conclusions This protocol has been approved by the Internal Review Board at the Connecticut Veterans Affairs and the study is in process. This protocol may assist other researchers conducting similar studies. International Registered Report Identifier (IRRID) DERR1-10.2196/33310

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A Research Agenda for Advancing Strategies to Improve Opioid Safety: Findings from a VHA State of the Art Conference

Cited by 14 publications

References 42 publications

Delphi study to explore a new diagnosis for “ineffective” long-term opioid therapy for chronic pain

Delphi study to explore a new diagnosis for “ineffective” long-term opioid therapy for chronic pain

Are x‐waiver trainings enough? Facilitators and barriers to buprenorphine prescribing after x‐waiver trainings

Classification of Patients for Whom Benefit of Long-term Opioid Therapy No Longer Outweighs Harm: Protocol for a Delphi Study

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