Abstract：
UNASSIGNED: The Veterans Health Administration (VA) implemented academic detailing (AD) to support safer opioid prescribing and overdose prevention initiatives.
UNASSIGNED: Patient-level data were extracted monthly from VA\'s electronic health record to evaluate whether AD implementation was associated with changes in all-cause mortality, opioid poisoning inpatient admissions, and opioid poisoning emergency department (ED) visits in an observational cohort of patients with long-term opioid prescriptions (≥45-day supply of opioids 6 months prior to a given month with ≤15 days between prescriptions). A single-group interrupted time series analysis using segmented logistic regression for mortality and Poisson regression for counts of inpatient admissions and ED visits was used to identify whether the level and slope of these outcomes changed in response to AD implementation.
UNASSIGNED: Among 955 376 unique patients (19 431 241 person-months), there were 53 369 deaths (29 025 pre-AD; 24 344 post-AD), 1927 opioid poisoning inpatient admissions (610 pre-AD; 1317 post-AD), and 408 opioid poisoning ED visits (207 pre-AD; 201 post-AD). Immediately after AD implementation, there was a 5.8% reduction in the odds of all-cause mortality (95% confidence interval [CI]: 0.897, 0.990). However, patients had a significantly increased incidence rate of inpatient admissions for opioid poisoning immediately after AD implementation (incidence rate ratio = 1.523; 95% CI: 1.118, 2.077). No significant differences in ED visits for opioid poisoning were observed.
UNASSIGNED: AD was associated with decreased all-cause mortality but increased inpatient hospitalization for opioid poisoning among patients prescribed long-term opioids. Mechanisms via which AD\'s efforts influenced opioid-related outcomes should be explored.
UNASSIGNED: Patient-level data were extracted monthly from VA\'s electronic health record to evaluate whether AD implementation was associated with changes in all-cause mortality, opioid poisoning inpatient admissions, and opioid poisoning emergency department (ED) visits in an observational cohort of patients with long-term opioid prescriptions (≥45-day supply of opioids 6 months prior to a given month with ≤15 days between prescriptions). A single-group interrupted time series analysis using segmented logistic regression for mortality and Poisson regression for counts of inpatient admissions and ED visits was used to identify whether the level and slope of these outcomes changed in response to AD implementation.
UNASSIGNED: Among 955 376 unique patients (19 431 241 person-months), there were 53 369 deaths (29 025 pre-AD; 24 344 post-AD), 1927 opioid poisoning inpatient admissions (610 pre-AD; 1317 post-AD), and 408 opioid poisoning ED visits (207 pre-AD; 201 post-AD). Immediately after AD implementation, there was a 5.8% reduction in the odds of all-cause mortality (95% confidence interval [CI]: 0.897, 0.990). However, patients had a significantly increased incidence rate of inpatient admissions for opioid poisoning immediately after AD implementation (incidence rate ratio = 1.523; 95% CI: 1.118, 2.077). No significant differences in ED visits for opioid poisoning were observed.
UNASSIGNED: AD was associated with decreased all-cause mortality but increased inpatient hospitalization for opioid poisoning among patients prescribed long-term opioids. Mechanisms via which AD\'s efforts influenced opioid-related outcomes should be explored.
摘要：
■退伍军人健康管理局（VA）实施了学术细节（AD），以支持更安全的阿片类药物处方和过量预防计划。
■每月从VA的电子健康记录中提取患者水平的数据，以评估AD实施是否与全因死亡率的变化有关，阿片类药物中毒住院患者，在长期阿片类药物处方的观察性队列中，以及阿片类药物中毒急诊科（ED）访视（给定月份前6个月阿片类药物供应≥45天，处方间隔≤15天）。使用单组中断时间序列分析，对死亡率进行分段逻辑回归，对住院患者和ED就诊计数进行泊松回归，以确定这些结果的水平和斜率是否因AD实施而发生变化。
■在955376名独特患者（19431241人-月）中，有53369例死亡（AD前29025例；AD后24344例），1927年阿片类药物中毒住院患者（AD前610；AD后1317），和408次阿片类药物中毒急诊就诊(207次AD前；201次AD后)。AD实施后，全因死亡率的几率降低了5.8%(95%置信区间[CI]:0.897,0.990).然而,患者在实施AD后立即因阿片类药物中毒入院的发生率显著增加(发生率比=1.523;95%CI:1.118,2.077).在阿片类药物中毒的ED访问中没有观察到显着差异。
■在长期服用阿片类药物的患者中，AD与全因死亡率降低相关，但因阿片类药物中毒住院的增加。应探索AD努力影响阿片类药物相关结局的机制。
■每月从VA的电子健康记录中提取患者水平的数据，以评估AD实施是否与全因死亡率的变化有关，阿片类药物中毒住院患者，在长期阿片类药物处方的观察性队列中，以及阿片类药物中毒急诊科（ED）访视（给定月份前6个月阿片类药物供应≥45天，处方间隔≤15天）。使用单组中断时间序列分析，对死亡率进行分段逻辑回归，对住院患者和ED就诊计数进行泊松回归，以确定这些结果的水平和斜率是否因AD实施而发生变化。
■在955376名独特患者（19431241人-月）中，有53369例死亡（AD前29025例；AD后24344例），1927年阿片类药物中毒住院患者（AD前610；AD后1317），和408次阿片类药物中毒急诊就诊(207次AD前；201次AD后)。AD实施后，全因死亡率的几率降低了5.8%(95%置信区间[CI]:0.897,0.990).然而,患者在实施AD后立即因阿片类药物中毒入院的发生率显著增加(发生率比=1.523;95%CI:1.118,2.077).在阿片类药物中毒的ED访问中没有观察到显着差异。
■在长期服用阿片类药物的患者中，AD与全因死亡率降低相关，但因阿片类药物中毒住院的增加。应探索AD努力影响阿片类药物相关结局的机制。
