Category: Federal Forum Posters
Purpose: The purpose of this study is to verify whether the Opioid Use Dashboard created by Academic Detailing correctly identifies patients who are at an increased risk for opioid use disorder (OUD) or currently have the OUD diagnosis who are not actively being treated at the Cheyenne VA Medical Center (CVAMC). With this information, we can then assess whether or not this patient population can benefit from pharmacist management from a buprenorphine/naloxone (SUBOXONE®) clinic. Currently the Cheyenne VA is below the national average of patients with active treatment in the Department of Veteran's Affairs.
Methods: Original data collection has been (July 2018) and will be conducted frequently (until years end) to assess patients on the Academic Detailing Dashboard for OUD and whether the patient meets criteria for an OUD diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V), or previously diagnosed from the DSM IV. Academic Detailing provided by the VA compiles patients based off of specific flags. Patient’s identified by the VA dashboard can be sorted and compiled based on these flags. For this study, the limit was set at 2 or more flags, or 1 flag (only if the flag was > 120 MMED).
The pharmacist will compile and assess the patient information from the OUD dashboard regarding patients identified as at risk, or with diagnosis and untreated with information compiled from VISN databases and confirm findings with other pharmacists of specialized fields (pain management, and mental health), and other appropriate health care professionals. To achieve the appropriate power, N=124 (obtained 197) will be required to determine if a statistically significant amount of patients are identified and require treatment intervention. An alpha of 0.5, and beta of 0.8 will be used for this project.
Results: We expect to see a trend of patients who are identified by the Opioid Use Disorder Dashboard correctly as patients who are at high risk for a diagnosis of opioid use disorder and meet the requirements for intervention or consult. The patients that are correctly identified will be presented to their primary care physician where they will be able to make the appropriate decision of whether these patients would benefit from diagnosis and treatment. The primary care physician can request the patient be treated for opioid use disorder and that it be pharmacist-managed treatment with orders verified and signed by appropriately licensed DEA-X Waiver physicians. During the on-going process of identifying patients, the goal is to extract the individuals who do have an increased risk while removing the patients who have little to no risk. Patients identified will have been analyzed by possibly 3 different pharmacists to ensure the correct patient population is being obtained. The patients that have been compiled throughout the first compilation of data are showing that the dashboard is correctly selecting patients that fall into the high-risk category of a use disorder.
Conclusion: Currently the Cheyenne VA Medical Center is below the national average for patients with Opioid Use Disorder diagnosis and treatment. This has shown that the dashboard created by Academic Detailing does select the appropriate patient population. With the dashboard using key indicators or flags, it helps identify who is appropriate for screening and treatment. Knowing that patients are correctly identified allows proper and appropriate actions to be taken to improve the veteran’s care.
Christopher Meyers– Pharmacy Resident, Cheyenne VA Medical Center, Cheyenne, WY