Yale University

Guideline-concordant management of opioid therapy among human immunodeficiency virus (HIV)-infected and uninfected veterans.

TitleGuideline-concordant management of opioid therapy among human immunodeficiency virus (HIV)-infected and uninfected veterans.
Publication TypeJournal Article
Year of Publication2014
AuthorsGaither, Julie R., Joseph L. Goulet, William C. Becker, Stephen Crystal, Jennifer E. Edelman, Kirsha Gordon, Robert D. Kerns, David Rimland, Melissa Skanderson, Daniel F. Weisberg, Amy C. Justice, and David A. Fiellin
JournalThe journal of pain : official journal of the American Pain Society
Date Published2014 Nov
KeywordsAdult, Analgesics, Opioid, Chronic Pain, Female, Guideline Adherence, HIV Infections, Humans, Male, Physician's Practice Patterns, Primary Health Care, United States, Veterans
AbstractWhether 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.
Alternate JournalJ Pain

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