1049 — Evaluating an Advanced Medication Alert to Reduce Opioid and Benzodiazepine Co-prescribing

Lead/Presenter: Eric Hawkins, COIN - Seattle/Denver
All Authors: Hawkins EJ (COIN-Seattle/Denver) Malte CA (COIN-Seattle/Denver) Saxon AJ (COIN-Seattle/Denver) Berger D (VA Puget Sound HCS) Hagedorn HJ (COIN- Minneapolis) Achtmeyer CE (VA Puget Sound HCS) Mariano AJ (VA Puget Sound HCS)

Objectives:
Due to trends in pharmaceutical overdoses involving opioid analgesics and benzodiazepines, reducing the co-prescribing of these medications is a national VA priority. For individuals with substance use disorders (SUDs), suicide risk or impaired breathing-related conditions such as sleep apnea, as well as the elderly (age >=65), the potentially lethal risks associated with concurrent use of these medications may be even greater. This project evaluates the effectiveness of an electronic health record advanced medication alert to reduce co-prescribing among Veterans with substance use (SUD) and other high risk conditions at VA Puget Sound healthcare system (VAPSHCS).

Methods:
This quality improvement project utilized administrative medical record data from the VISN 20 Corporate Data Warehouse, which included data elements from the medication alert. Using interrupted time series design, we examined population-level trends in co-prescribing during 12-months after the alert launch, after adjusting for secular trends in co-prescribing during the year prior to launch and demographic and clinical covariates. Separate logistic regressions modeled changes in co-prescribing for SUD and other high risk conditions. Prescribing trends at VAPSHCS were compared to those of a similar VA healthcare system without the alert. To assess if the alert impacted the medications differently, secondary analyses examined population trends in opioid analgesic and benzodiazepine prescribing separately.

Results:
Over 12 months, the alert activated for 1,332 patients. Significant decreases in co-prescribing were observed in the 12 months following the alert launch for patients with SUD (AOR = 0.97, 95%CI: 0.96-0.99, p = 0.002), sleep apnea (AOR = 0.97, 95%CI: 0.95-0.98, p < 0.001), and suicide risk (AOR = 0.94, 95% CI: 0.91-0.98, p = 0.005). Decreases in co-prescribing at VAPSHCS were significantly different from the comparison site among those in the suicide risk (AOR = 0.92,95% CI: 0.86-0.97) and sleep apnea (AOR = 0.98, 95%CI: 0.96-1.00) cohorts. Significant decreases in benzodiazepine prescribing trends were observed only at VAPSHCS.

Implications:
Relative to the comparison site, greater decreases in co-prescribing were observed among patients with sleep apnea and suicide risk. The alert's ability to reach mental health prescribers who prescribe the majority of benzodiazepines may have contributed to these decreases.

Impacts:
Advanced medication alerts hold promise as means of reducing the co-prescribing of opioids and benzodiazepines among certain high risk groups.