VA Puget Sound Health Care System’s https://www.pudgetsound.va.gov quality improvement project suggests that electronic medication alerts can lower co-prescribing of opioids and benzodiazepines in high risk patients. Benzodiazepines are drugs such as Valium with sedative properties and opioids are medications used to relieve pain.
Opioids and benzodiazepines are the most common drug classes involved in pharmaceutical overdoses. About 27 percent of veterans enrolled in VA healthcare who are prescribed opioids are also prescribed benzodiazepines according to researchers.
Researchers used VA’s electronic medical record system to automatically alert care providers prescribing either opioids or benzodiazepine when patients with high risk conditions had prescriptions for the other drug class. Using alerts helped to drastically reduce co-prescribing for the two medications especially for high risk patients.
Using the alert system may also help to provide coordination between primary care providers and mental health medical services. Opioids are usually prescribed in primary care while benzodiazepines are more likely to be prescribed in mental healthcare.
Recently, the VA has increased the integration of mental healthcare into primary care. In the future, the VA’s goal is to increase co-location of the two services so that it may become possible for a primary care doctor to send a patient to a mental health counselor located in the same building rather than referring the veteran to a different clinic at a distance.
According to the VA, more studies are needed to determine if combining the system with other interventions such as audits and support for drug tapering and pain management will help further to reduce co-prescribing and whether such interventions will help improve patient outcomes and prevent overdoses.
Efforts are now underway to roll out the alert system nationwide. So far, it has been disseminated to several VA healthcare systems beyond VA Puget Sound. The researchers have also collaborated with VA Pharmacy Benefits Management Services https://www.pbm.va.gov to develop a national alert to identify any patients co-prescribed opioids and benzodiazepines.