Impact of Implementing an Academic Detailing Program on Opioid-Benzodiazepine Co-Prescribing Trends at the U.S. Department of Veterans Affairs

Abstract

Objectives To assess the process and outcomes of academic detailing to enhance the Opioid Safety Initiative and the Psychotropic Drug Safety Initiative to reduce co-prescribing of opioid-benzodiazepine combinations in veterans. Methods A retrospective cohort design was conducted to evaluate the impact of implementing an academic detailing program on opioid-benzodiazepine co-prescribing between October 2014 through March 2019 at the U.S. Department of Veterans Affairs (VA). The primary outcome was the monthly prevalence of veterans (number per 1,000 population) who were co-prescribed opioid-benzodiazepine combination. Process measure was evaluated using implementation reach (proportion of providers who received academic detailing). Station-level analysis was performed using a linear fixed effects regression model to evaluate the rate of change in the prevalence of veterans co-prescribed opioid-benzodiazepine. Results Altogether 130 VA stations was included for analysis; 119 stations implemented opioid-related or benzodiazepine-related academic detailing, and 11 stations did not. Stations that had implemented academic detailing had a 33% greater monthly reduction on the opioid-benzodiazepine co-prescribing prevalence compared to stations that did not implement academic detailing (P = .036). In the linear fixed effects regression model, stations that were expected to have 100% of providers exposed to academic detailing were statistically associated with a greater decrease in the monthly prevalence of Veterans co-prescribed opioid-benzodiazepine by 4.9 veterans per 1,000 population (P < .001) compared to stations with 0% of providers exposed to academic detailing. Conclusions Stations that implemented academic detailing and had a higher proportion of providers who were exposed to opioid- or benzodiazepine-related academic detailing had a significant decrease in the monthly prevalence of Veterans co-prescribed opioid-benzodiazepine combinations.

Trends in substance use disorder diagnoses among Veterans, 2009–2019

“…Within VA, programs have tackled high-risk opioid and sedative co-prescribing and may have slowed the increase in these use disorders as a result. [30][31][32] In addition, VA's move from ICD-9 to ICD-10 in 2015, and discussions around the changing definitions of substance-specific disorders with the release of DSM-5, may have curbed the increasing trend in diagnosed disorders. It is less likely the trends reflect an increase in systematic underdiagnosis of opioid or sedative use disorders.…”

“…Diagnoses for these disorders leveled off during a period of increased recognition of the opioid crisis and the risks of polypharmacy. Within VA, programs have tackled high‐risk opioid and sedative co‐prescribing and may have slowed the increase in these use disorders as a result 30–32 . In addition, VA's move from ICD‐9 to ICD‐10 in 2015, and discussions around the changing definitions of substance‐specific disorders with the release of DSM‐5, may have curbed the increasing trend in diagnosed disorders.…”