Summer 2016

In this Issue: Improving the Safety of Prescription Opioid Use among Veterans » Table of Contents

Effects of VHA Opioid Policy on Prescribing and Patient-Centered Outcomes

Ongoing Study

Opioid analgesics are the most commonly prescribed medications for chronic pain. However, an emerging public health epidemic of opioid-related harms – especially abuse and overdose – has triggered a new era in opioid attitudes and policies, in which opioid prescribing trends are being actively reversed. VA has been a national leader in pain management and has recently implemented the Opioid Safety Initiative (aims to increase use of opioid risk management tools and decrease high-risk prescribing practices) and mandatory written informed consent for long-term opioid therapy. These initiatives are anticipated to substantially reduce rates and intensity of opioid prescribing in VA. The main objective of this ongoing HSR&D study (July 2015 - June 2019) is to understand patient-centered outcomes of opioid prescribing changes among Veterans treated with long-term opioids for chronic pain.

A nationally representative sample of VA primary care patients receiving long-term opioid therapy (n= 13,675) will be invited to participate in a mailed survey, in order to collect longitudinal patient-reported pain outcomes data. Specific aims are to:

• Examine the relationship between changes in prescribed opioids and changes in patient-reported pain and quality-of-life (QOL) outcomes; and
• Identify any associations of patient, provider, and facility factors with changes in patient-reported pain and QOL, primarily through their influence on opioid prescribing and use of non-pharmacological pain therapies.

Patients are asked to complete brief questionnaires at three time points during the study: baseline, 12 months, and 24 months. Questionnaires assess pain-related function and health-related QOL as the primary outcomes, and evaluate pain characteristics, patient perceptions of care, and use of non-pharmacological therapies as covariates. VA administrative data will be used to assess patient use of pain-related health services and patient, provider, and facility covariates. Prospective patient-reported survey data will be merged with administrative data for analyses to address the specific aims.

Thus far, a pilot survey wave has been completed with a 71% response rate (355 respondents/498 contacted). The main baseline survey mailing is in progress.

Impact

Study findings will contribute to identifying successful approaches and targeting potential gaps in VA efforts to achieve patient-centered pain management and opioid safety goals.

View study abstract

Principal Investigator: Erin Krebs, MD, MPH, is part of HSR&D's Center for Chronic Disease Outcomes Research (CCDOR) in Minneapolis, MN.