Abstract
Objective
The Veterans Health Administration (VHA) is the largest integrated health care system
in the U.S., serving approximately 2.5 million Veterans in the Emergency Department/Urgent
Care Centers (ED/UCC) each year. Variation in opioid prescribing by ED/UCC providers
in the VHA is described.
Methods
This is an observational study using administrative data from the VHA Pharmacy Benefits
Management Services database to assess ED/UCC providers' opioid prescribing rates
between October 1st, 2014 to June 30th, 2017 in 121 U.S. facilities. The opioid prescribing
rate was defined as the number of opioid prescriptions written by the provider divided
by the number of patients discharged from the ED/UCC by that provider, by quarter.
A regression analysis was performed to estimate the association between time and prescribing
rates by provider.
Results
Overall, the national trend in median prescribing rates decreased by 25.5% (p value = 0.00)
from 9.1% ([range 1.5%–25.6%] to 6.4% [range 0.8%–21.8%]). The greatest rates of decline
occurred between January 1st, 2016 to June 30th, 2017. The rate of provider opioid
prescribing demonstrated wide variability between facilities (range: 0.5% to 39.1%).
The prescribing rate for ED/UCC providers ranged from 0.2% to 100%. Between June 2016
and May 2017, 24 VHA ED/UCC providers were the highest opioid prescribers nationally
in at least two of the four quarters (22%–70%), with rates two- to three-fold higher
than their peers.
Conclusion
ED/UCC providers in the VHA system nationally vary considerably in rates of opioid
prescribing. A focused initiative tailored for ED/UCC providers is needed to decrease
opioid prescribing variability.
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Article Info
Publication History
Published online: August 17, 2018
Accepted:
August 15,
2018
Received:
July 20,
2018
Identification
Copyright
Published by Elsevier Inc.
