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Healthcare system-wide implementation of opioid-safety guideline recommendations: the case of urine drug screening and opioid-patient suicide- and overdose-related events in the Veterans Health Administration

  • Original Research
  • Published:
Translational Behavioral Medicine

Abstract

This study provides an example of how healthcare system-wide progress in implementation of opioid-therapy guideline recommendations can be longitudinally assessed and then related to subsequent opioid-prescribed patient health and safety outcomes. Using longitudinal linear mixed effects analyses, we determined that in the Department of Veterans Affairs (VA) healthcare system (n = 141 facilities), over the 4-year interval from 2010 to 2013, a key opioid therapy guideline recommendation, urine drug screening (UDS), increased from 29 to 42 %, with an average within-facility increase rate of 4.5 % per year. Higher levels of UDS implementation from 2010 to 2013 were associated with lower risk of suicide and drug overdose events among VA opioid-prescribed patients in 2013, even after adjusting for patients’ 2012 demographic characteristics and medical and mental health comorbidities. Findings suggest that VA clinicians and healthcare policymakers have been responsive to the 2010 VA/Department of Defense (DOD) UDS treatment guideline recommendation, resulting in improved patient safety for VA opioid-prescribed patients.

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Acknowledgments

This work was supported in part by a VA HSR&D QUERI grant RRP 10-106. We thank the VA Opioid Metric Development Team (William Becker, Rollin Gallagher, Francine Goodman, Patricia Henderson, James Im, Robert Kerns, Amanda Midboe, and Jack Rosenberg) for their work developing the measures used in this study, Amanda Midboe for her helpful comments on an earlier version of this manuscript, and Sonya SooHoo for assisting with manuscript preparation. The views expressed here are those of the authors and do not necessarily reflect positions or policies of the Department of Veterans Affairs or of the US government.

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Author notes

  1. Penny L. Brennan Ph.D.

    Present address: Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park Division, 795 Willow Road, Menlo Park, CA, 94025, USA

Authors and Affiliations

  1. Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park Division, 795 Willow Road, Menlo Park, CA, 94025, USA

    Aaron C. Del Re Ph.D., Patricia T. Henderson M.S. & Jodie A. Trafton Ph.D.

Authors
  1. Penny L. Brennan Ph.D.
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  2. Aaron C. Del Re Ph.D.
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  3. Patricia T. Henderson M.S.
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  4. Jodie A. Trafton Ph.D.
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Corresponding author

Correspondence to Penny L. Brennan Ph.D..

Ethics declarations

Research reported here was supported in part by the Department of Veterans Affairs Health Services Research and Development (HSR&D) grant number RRP 10-106. All work performed in this investigation was in accordance with the ethical standards of our institutional research committees and with the 1964 Helsinki Declaration and its later amendments. For this type of study, formal consent is not required. This research was approved by the Stanford University administrative panels for the protection of human subjects.

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Implications

For researchers, this study provides an example of how healthcare system-wide electronic patient treatment data can be used to operationalize and measure patient treatment guideline implementation and the use of a longitudinal linear mixed effects statistical approach to determine associations between implementation metrics and patient health and safety outcomes. For clinicians, this study contributes to the evidence base for urine drug screening as a promising tool for improving opioid-prescribed patient safety. For healthcare providers and policy makers, results of studies such as this can help guide clinical practices and healthcare system resource allocations that better balance the desire to provide patients with accessible, effective relief for pain with evidence-based practices that protect them from adverse medical events associated with opioid therapy.

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Brennan, P.L., Del Re, A.C., Henderson, P.T. et al. Healthcare system-wide implementation of opioid-safety guideline recommendations: the case of urine drug screening and opioid-patient suicide- and overdose-related events in the Veterans Health Administration. Behav. Med. Pract. Policy Res. 6, 605–612 (2016). https://doi.org/10.1007/s13142-016-0423-7

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  • DOI: https://doi.org/10.1007/s13142-016-0423-7

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