Impact of Academic Detailing on Opioid Prescribing at the Veterans Health Administration

Bounthavong Mark,Popish Sarah J,Kay Chad L,Christopher Melissa Ld,Mullins-Cunningham Sophia,Himstreet Julianne E,Morillo Christina,Lau Marcos K,Wells Daina L,Harvey Michael A,Freeman Blake A,Phillips Andrea G

doi:10.36959/377/349

Abstract

In 2014, the United States Veterans Health Administration (VHA) Pharmacy Benefits Management Academic Detailing Service (ADS) began national implementation of academic detailing (AD), a one-on-one educational outreach program delivered by specially trained clinical pharmacy specialists to address mental health disorders and pain management. Consequently, ADS adopted the mission of the VHA Opioid Safety Initiative (OSI) to align providers' opioid prescribing with evidence-based practice.

Highlights

In 2014, the United States Veterans Health Administration (VHA) Pharmacy Benefits Management Academic Detailing Service (ADS) began national implementation of academic detailing (AD), a one-on-one educational outreach program delivered by specially trained clinical pharmacy specialists to address mental health disorders and pain management
In the U.S, mortality risk associated with drug overdose was twice as high in veterans compared to the general population [4], which was likely caused by increased opioid utilization between 2001 and 2007 (184% for methadone, 60% for synthetic and semisynthetic opioids, and 35% for non-synthetic opioids) [5]
Providers who were exposed to academic detailing had a larger reduction in the proportion of Veterans on high-dose opioids between month 36 and baseline compared to providers unexposed to academic detailing

Summary

Introduction

ADS adopted the mission of the VHA Opioid Safety Initiative (OSI) to align providers’ opioid prescribing with evidence-based practice. This program evaluation assessed AD’s impact on the monthly trends of highdose opioid utilization and average morphine milligram equivalent (MME) between providers exposed (AD-exposed) and unexposed (AD-unexposed) to OSI-specific educational outreach. The annual death toll due to opioids was over 46,000 in 2018 [1] and exceeded that of motorized vehicles by 150% starting in 2014 [2] This was paralleled by a 64% increase in opioid-related inpatient stays and a doubling of the rate of opioid-related emergency department visits from 2005 to 2014 in the general population [3].

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Discussion

Conclusion