Health care utilization by veterans prescribed chronic opioids

Abstract

PurposeAmbulatory resources such as telephone calls, secure messages, nurse visits, and telephone triage are vital to the management of patients on chronic opioid therapy (COT). They are also often overlooked as health care services and yet to be broadly studied. The aim of the present study was to describe the Veterans Affairs (VA) health care utilization by patients based on COT, type, and amount of opioids prescribed.Patients and methodsA retrospective chart review was done on 617 patients on COT at a VA primary care clinic. Instances of health care utilization (emergency department visits [EDVs], hospitalizations, clinic visits, telephone triage calls, telephone calls/secure messages/nurse visits) were obtained.ResultsPatients were likely to have more telephone calls, secure messages, or nurse visits if they were prescribed a schedule II opioid or if they were on more than one opioid. Model-based results found that patients on COT were more likely to have EDVs, telephone triage calls, and clinic contact compared to patients who were not on chronic opioids.ConclusionThe results are despite having a Patient Aligned Care Team, which is the VA’s patient-centered medical home. This suggests that reducing health care utilization for patients on COT may not be possible with just a primary care involvement.

Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation

“…Reports suggest that nearly two-thirds of veterans experience pain [ 3 ], with even greater pain prevalence observed among certain veteran cohorts [ 4 - 6 ]. This pain experience leads to negative consequences including functional impairment [ 7 ], increased stress and mental health concerns [ 8 , 9 ], substance abuse [ 8 , 9 ], risky opioid use [ 10 ], impaired sleep [ 9 ], decreased quality of life [ 11 ], and increased health care utilization [ 12 ]. Accordingly, safe and effective strategies are needed to help veterans manage pain.…”

High frequency of long-term opioid use among patients with rheumatic and musculoskeletal diseases initiating opioids for the first time

“…Definition 2 (labelled as Stringent ): ≥10 opioid prescriptions filled over >90 days, or ≥120 days' opioid supply, in the first year of follow-up 5. Definition 3 (labelled as Broad ): ≥3 opioid prescriptions at monthly intervals, which do not need to be consecutive, in the first 12 months 6. AxSpA, axial spondyloarthritis; OA, osteoarthritis; PsA, psoriatic arthritis; RA, rheumatoid arthritis; RMD, rheumatic and musculoskeletal diseases; SLE, systemic lupus erythematosus.…”

Rethinking “long term” opioid therapy

“…In clinical practice, strict definitions such as “more than six months of use”3 may result in missed opportunities to identify people at risk of harm earlier, when stopping opioids may be simpler and more effective. Conversely, lax definitions such as “at least three opioid prescriptions in the last year”4 may flag up people who are taking opioids intermittently for occasional exacerbations (of osteoarthritis or endometriosis, for example) and are at low risk of opioid related harm.…”