Journal of Pain Research (May 2022)
Impact of Informed Consent and Education on Care Engagement After Opioid Initiation in the Veterans Health Administration
Abstract
Tigran Avoundjian,1 Lara Troszak,1,2 Jennifer Cohen,3,4 Mary Beth Foglia,3,5 Jodie Trafton,1,6,7 Amanda Midboe1,2 1Center for Innovation to Implementation, Va Palo Alto Health Care System, Palo Alto, CA, USA; 2School of Medicine, Stanford University, Stanford, CA, USA; 3National Center for Ethics in Health Care, Veterans Affairs, Seattle, WA, USA; 4Department of Epidemiology, University of Washington, Seattle, WA, USA; 5Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA; 6Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA; 7VA Office of Mental Health and Suicide Prevention, VA Palo Alto Healthcare System, Menlo Park, CA, USACorrespondence: Tigran Avoundjian, Center for Innovation to Implementation, 745 Willow Road, Menlo Park, CA, 94205, USA, Fax +206-296-4803, Email [email protected]: To ensure all patients receiving long-term opioid therapy (LTOT) understand the risks, benefits and treatment alternatives, the Veterans Health Administration (VHA) released a national policy in 2014 to standardize a signature informed consent (SIC) process. We evaluated the impact of this policy on medical follow-up after LTOT initiation, a guideline recommended practice.Methods: Using VHA administrative data, we identified patients initiating LTOT between May 2013 and May 2016. We used an interrupted time series design to compare the monthly rates of medical follow-up within 30 days and primary care visits within 3 months after LTOT initiation across three periods: 12 months before the policy (Year 1); 12 months after policy release (Year 2); and 12– 24 months after policy release, when the SIC process was mandatory (Year 3).Results: Among the 409,895 patients who experienced 758,416 LTOT initiations, medical follow-up within 30 days and primary care engagement within 3 months increased by 4% between Year 1 and Year 3. Compared to Year 1, patients in Year 3 were 1.12 times more likely to have any medical follow-up (95% CI: 1.10, 1.13) and 1.13 times more likely to have a primary care visit (95% CI: 1.12, 1.15). Facilities with a greater proportion of patients receiving SIC had increased medical follow-up (RR: 1.04, 95% CI: 1.01, 1.07) and primary care engagement (RR: 1.06, 95% CI: 1.03, 1.10).Conclusion: The VHA’s SIC policy is associated with increased medical follow-up among patients initiating LTOT, which may result in improved patient safety and has implications for other healthcare settings.Keywords: chronic pain, opioid therapy, informed consent, care engagement
