A Retrospective Chart Review Comparing Long-Term Opioid Prescribing Practices Between Care in the Community and...

Using Veterans Affairs (VA) clinical practice guidelines as a reference, this study compared long-term opioid prescribing practices and risk mitigation strategies in veterans receiving care at the Greater Los Angeles VA compared with veterans receiving Care in the Community (CITC). A retrospective chart review was performed on 46 CITC patients and a random sample of 50 VA patients who received 90 days or more of an opioid prescription between July 1, 2018, and June 30, 2019, and were followed for 1 year.

The 2 populations were prescribed similar opioid treatments, and although not statistically significant, there was a trend toward CITC prescribing higher mean daily morphine equivalent values (VA = 32.71 ± 41.34, CITC = 48.22 ± 56.85, P = .13). The most commonly prescribed opioids were hydrocodone and oxycodone products. The vast majority of pain diagnoses were seen in equivalent numbers across the VA and CITC groups. VA prescribers more frequently recommended nonpharmacological options (86% VA vs 82.61% CITC, P = .65) and nonopioid co-analgesics compared with CITC providers (80% VA vs 63.04% CITC, P = .07). Veterans Affairs providers also more frequently completed informed consent for long-term opioid use (96% vs 65.22%, P < .005), Prescription Drug Monitoring Program checks (98% vs 93.48%, P = .25), and urine drug screens (92% vs 69.57%, P = .006). Veterans Affairs providers prescribed concurrent benzodiazepines less frequently than CITC providers (8% vs 15.22% P = .28); however, CITC providers more frequently saw patients at 3-month intervals (60.9% vs 26%, P < .005). Finally, both groups had similar naloxone kit prescribing rates (30.4% CITC vs 30% VA, P = .96).

Overall, opioid prescribing behaviors between VA and CITC providers were similar. However, this study also identified a trend for the VA providing lower doses of opioids and improved safety measures. Future studies are needed to understand areas of collaboration and mechanisms to improve veterans' pain care across all health care settings.