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- Veterans Health Administration (VHA) providers need to enhance their state-run prescription drug monitoring program (PDMP) use, according to a recent Government Accountability Office (GAO) report.

Investigators assessed VA’s progress in improving opioid safety among veteran patients and determined that the federal department has not yet met all of its opioid safety goals developed as part of the Opioid Safety Initiative (OSI). Furthermore, VA providers are not consistently adhering to evidence-based opioid risk mitigation strategies.

GAO investigators reviewed a sample of 103 veteran EHRs at five VHA medical facilities and found 40 veterans did not have their names queried in a state-run PDMP.

PDMPs allow providers to search for patient EHRs and access a comprehensive picture of a patient’s controlled substance and prescription history.

In accordance with the opioid risk mitigation strategies outlined in OSI, VHA providers are required to query state PDMPs at least annually when prescribing opioids to determine if a veteran has obtained opioid medications or other controlled substances from a non-VA provider.

Only 26 percent of veterans in its sample had their names queried in a PDMP, according to GAO’s investigation.

“We identified a number of factors that may have contributed to the inconsistent adherence to the three key opioid risk mitigation strategies at our selected VHA medical facilities,” stated GAO investigators in the report. “These factors may impede providers’ ability to consistently follow these strategies for all applicable patients at these facilities.”

GAO pointed to problems with PDMP access as a main factor that may have obstructed VHA providers’ abilities to follow through on key opioid risk management strategies.

“Officials at four of the five selected medical facilities faced PDMP access issues,” explained GAO investigators. “Officials at two facilities told us that not all facility staff can access state PDMPs due to state laws and regulations that do not allow access to all types of providers, such as nurses and pharmacists.”

VHA officials at one healthcare facility stated nurse practitioners are unable to access the state’s PDMP due to state laws and regulations that bar nurses and pharmacists from viewing health information contained in the PDMP.

“In addition, in some states, only providers licensed in the state may access the state’s PDMP,” wrote investigators. “Because providers at VHA facilities may not be licensed in the state where the VHA facility is located but licensed in another state, these providers may be unable to access the state’s PDMP.”

Ultimately, GAO made five recommendations to help VHA providers improve opioid safety and execution of opioid risk mitigation strategies. 

First, GAO recommended the Undersecretary for Health ensure the Central Office, Veterans Integrated Service Networks (VISN), and medical facilities document actions they take to improve OSI goals. GAO also recommended the Undersecretary for Health ensure any OSI goals that have not been met have clearly defined, measurable outcomes.

GAO also suggested government bodies track the use of the Opioid Risk Report and other tools prior to initiating opioid therapy. The regulatory body also said VISNs should implement academic detailing programs that support all medical facilities in the VISN and that all VHA medical facilities have a designated primary care pain champion as required.

Finally, GAO recommended all VHA medical facilities ensure providers are improving their adherence to opioid risk mitigation strategies—including the use of PDMPs, written informed consent, and urine drug screening.

“These steps could include creating alerts in the electronic medical record system to remind primary care teams when these actions should be completed or strengthening facility monitoring of providers,” GAO concluded.

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