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Abstract
Background: Benzodiazepine use in the US Veterans Administration (VA) has been decreasing; however, a small number of veterans with posttraumatic stress disorder (PTSD) continue to receive benzodiazepine. Academic detailing, a targeted-educational outreach intervention, was implemented at VA to help reduce the disparity between existing and evidence-based practices, including the reduction in benzodiazepine use in veterans with PTSD. Since evidence to support the national implementation of academic detailing in this clinical scenario was scarce, we performed a quality improvement evaluation on academic detailing’s impact on benzodiazepine use in veterans with PTSD. Methods: A retrospective cohort design was used to evaluate the impact of academic detailing on benzodiazepine prescribing in veterans with PTSD from January 1, 2016, to December 31, 2016. Providers exposed to academic detailing (AD-exposed) were compared with providers unexposed to academic detailing (AD-unexposed) using generalized estimating equations (GEEs) controlling for baseline covariates. Secondary aims evaluated academic detailing’s impact on average lorazepam equivalent daily dose (LEDD), total LEDD, and benzodiazepine day supply. Results: Overall, there was a decrease in the prevalence in benzodiazepine use in veterans with PTSD from 115.5 to 103.3 per 1000 population (P < .001). However, the decrease was greater in AD-exposed providers (18.37%; P < .001) compared with AD-unexposed providers (8.74%; P < .001). In the GEE models, AD-exposed providers had greater reduction in the monthly prevalence of veterans with PTSD and a benzodiazepine prescription compared with AD-unexposed providers, by −1.30 veterans per 1000 population (95% confidence interval [CI]: −2.14, −0.46). Similar findings were reported for the benzodiazepine day supply; however, no significant differences were reported for total and average LEDD. Conclusions: Although benzodiazepine use has been decreasing in veterans with PTSD, opportunities to improve prescribing continue to exist at the VA. In this quality improvement evaluation, AD-exposed providers were associated with a greater reduction in the prevalence of veterans with PTSD and a benzodiazepine prescription compared with AD-unexposed providers.
Acknowledgments
We would like to acknowledge the Veterans Health Administration (VHA) Pharmacy Benefits Management Services leadership, Virginia Torrise and Michael Valentino; their continued support and guidance were instrumental for the program’s implementation and sustainability. We also want to acknowledge the clinical pharmacists who perform academic detailing duties across the VA every day. Their tireless effort to deliver key messages on appropriate benzodiazepine use is a critical part of improving the quality of health care for our veterans. Additionally, this work wouldn’t have been possible without the partnership with the VA Psychotropic Drug Safety Initiative—we thank Ilse Wiechers and her team for continually striving to provide education and awareness about psychotropic drug use across the VA. We are also incredibly grateful to our program specialists, Priyanka P. Randeria-Noor, Andrea Grana, Blake Freeman, and Christina M. Morillo, without their uplifting personalities and invaluable contributions to the day-to-day operations, the academic detailing program wouldn’t be possible. The comments and suggestions from the peer reviewers were helpful in improving and refining our submission; we are grateful for their contributions. Finally, we acknowledge the veterans and uniformed services personnel whose sense of duty, honor, and sacrifice continue to protect the liberty and freedom we enjoy.