Opioid Prescribing Showed Great Variance Across VHA

IOWA CITY, IA – Opioid prescribing dramatically increased at the VHA during an eight year period ending in 2012 but demonstrated wide variation in prevalence and incident rates across geographical region, sex and age groups.

Prevalence and incidence rates reflect distinct prescribing practices, according to the study, published recently in the Journal of General Internal Medicine.1

That areas with the highest prevalence tended to have lower increases in incident opioid dispensing over the study period likely reflects facility-level variations in prescribing practices as well as baseline rates of prevalent use, according to the study led by researchers from the Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System.

The study looked at all patients receiving primary care within 137 VHA healthcare systems during a given study year and receiving medications from VHA one year before and during a given study year.

Results indicated that the overall prevalence of opioid receipt increased from 18.9 % of all veteran outpatients in FY 2004 to 33.4 % in FY 2012, a 76.7 % relative increase.

In fiscal year 2012, women had higher rates of prevalent opioid receipt than men — 42.4 % vs. 32.9 % — while the youngest veterans 18-34 years had substantially higher prevalent opioid receipt compared with veterans 80 and older — 7.6 % vs. 17.9 %).

Increased rates of prevalent opioid receipt occurred in all regions in the United States during the time period, but prevalence rates varied widely by facility. In FY 2012, for example, the lowest-prescribing facility had a rate of 13.5 %, and the highest of 50.8 %.

Annual incident opioid receipt increased from 8.8 % in FY 2004 to 10.2 % in FY 2011, with a decline to 9.8 % in FY 2012. Incident prescribing increased at some facilities and decreased at others, according to the authors, who noted that facilities with high prevalent prescribing tended to have flat or decreasing incident prescribing rates during the study timeframe.

“Future work assessing opioid prescribing should employ methodologies to account for and interpret both prevalent and incident opioid receipt,” the authors suggest.

  1. Mosher HJ, Krebs EE, Carrel M, Kaboli PJ, Weg MW, Lund BC. Trends in Prevalent and Incident Opioid Receipt: an Observational Study in Veterans Health Administration 2004-2012. J Gen Intern Med. 2014 Dec 18. [Epub ahead of print] PubMed PMID: 25519224.

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