@article {4788,
	title = {Guideline-concordant management of opioid therapy among human immunodeficiency virus (HIV)-infected and uninfected veterans.},
	journal = {The journal of pain : official journal of the American Pain Society},
	volume = {15},
	year = {2014},
	month = {2014 Nov},
	pages = {1130-40},
	abstract = {Whether patients receive guideline-concordant opioid therapy (OT) is largely unknown and may vary based on provider and patient characteristics. We assessed the extent to which human immunodeficiency virus (HIV)-infected and uninfected patients initiating long-term (>= 90 days) OT received care concordant with American Pain Society/American Academy of Pain Medicine and Department of Veterans Affairs/Department of Defense guidelines by measuring receipt of 17 indicators during the first 6 months of OT. Of 20,753 patients, HIV-infected patients (n = 6,604) were more likely than uninfected patients to receive a primary care provider visit within 1 month (52.0\% vs 30.9\%) and 6 months (90.7\% vs 73.7\%) and urine drug tests within 1 month (14.8\% vs 11.5\%) and 6 months (19.5\% vs 15.4\%; all P < .001). HIV-infected patients were also more likely to receive OT concurrent with sedatives (24.6\% vs 19.6\%) and a current substance use disorder (21.6\% vs 17.2\%). Among both patient groups, only modest changes in guideline concordance were observed over time: urine drug tests and OT concurrent with current substance use disorders increased, whereas sedative coprescriptions decreased (all Ps for trend < .001). Over a 10-year period, on average, patients received no more than 40\% of recommended care. OT guideline-concordant care is rare in primary care, varies by patient/provider characteristics, and has undergone few changes over time.},
	keywords = {Adult, Analgesics, Opioid, Chronic Pain, Female, Guideline Adherence, HIV Infections, Humans, Male, Physician{\textquoteright}s Practice Patterns, Primary Health Care, United States, Veterans},
	issn = {1528-8447},
	doi = {10.1016/j.jpain.2014.08.004},
	author = {Gaither, Julie R and Goulet, Joseph L and Becker, William C and Crystal, Stephen and Edelman, E Jennifer and Gordon, Kirsha and Kerns, Robert D and Rimland, David and Skanderson, Melissa and Weisberg, Daniel F and Justice, Amy C and Fiellin, David A}
}
