title: Guideline-concordant management of opioid therapy among human immunodeficiency virus (HIV)-infected and uninfected veterans.
abstract: Whether patients receive guideline-concordant opioid therapy (OT) is largely unknown and may vary based on provider and patient characteristics. We assessed the extent to which human immunodeficiency virus (HIV)-infected and uninfected patients initiating long-term (≥ 90 days) OT received care concordant with American Pain Society/American Academy of Pain Medicine and Department of Veterans Affairs/Department of Defense guidelines by measuring receipt of 17 indicators during the first 6 months of OT. Of 20,753 patients, HIV-infected patients (n = 6,604) were more likely than uninfected patients to receive a primary care provider visit within 1 month (52.0% vs 30.9%) and 6 months (90.7% vs 73.7%) and urine drug tests within 1 month (14.8% vs 11.5%) and 6 months (19.5% vs 15.4%; all P < .001). HIV-infected patients were also more likely to receive OT concurrent with sedatives (24.6% vs 19.6%) and a current substance use disorder (21.6% vs 17.2%). Among both patient groups, only modest changes in guideline concordance were observed over time: urine drug tests and OT concurrent with current substance use disorders increased, whereas sedative coprescriptions decreased (all Ps for trend < .001). Over a 10-year period, on average, patients received no more than 40% of recommended care. OT guideline-concordant care is rare in primary care, varies by patient/provider characteristics, and has undergone few changes over time.
  
  
  CONCLUSIONS
  The promulgation of OT clinical guidelines has not resulted in substantive changes over time in OT management, which falls well short of the standard recommended by leading medical societies. Strategies are needed to increase the provision of OT guideline-concordant care for all patients.
authors.affiliation: Yale School of Public Health, Yale University, New Haven, Connecticut; Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, Connecticut. Electronic address: julie.gaither@yale.edu.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Gaither
authors.affiliation: Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Goulet
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: William C
authors.initials: WC
authors.lastname: Becker
authors.affiliation: Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey.
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.affiliation: Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: E Jennifer
authors.initials: EJ
authors.lastname: Edelman
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Kirsha
authors.initials: K
authors.lastname: Gordon
authors.affiliation: Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.affiliation: Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia; Atlanta VA Medical Center, Decatur, Georgia.
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.affiliation: VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Weisberg
authors.affiliation: Yale School of Public Health, Yale University, New Haven, Connecticut; Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.affiliation: Yale School of Public Health, Yale University, New Haven, Connecticut; Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards; D014481:United States; D014728:Veterans
chemical_list: D000701:Analgesics, Opioid
keywords: HIV; Opioid analgesics; chronic pain; practice guideline; quality of health care