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首页> 外文期刊>Substance abuse: official publication of the Association for Medical Education and Research in Substance Abuse >Cultivating change door to door: Educational outreach to improve prescribing practices in rural veterans with posttraumatic stress disorder
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Cultivating change door to door: Educational outreach to improve prescribing practices in rural veterans with posttraumatic stress disorder

机译：培养变化门到门：教育外展，以改善农村退伍军人的处方实践

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Background: Clinical guidelines for the management of posttraumatic stress disorder (PTSD) recommend against the use of benzodiazepines. Benzodiazepines and PTSD are both associated with addiction-related risks. The Department of Veterans Affairs (VA) prescribing trends show continued use of benzodiazepines and polysedative use in veterans with PTSD, particularly in rural areas. The authors examine the use of an educational intervention to improve pharmacologic management of veterans with PTSD in rural clinics. Methods: The VA Academic Detailing Service Informatics Toolset provides prescribing, demographic and risk factor data for veterans with PTSD treated at the White River Junction VA Medical Center (WRJ VA) and affiliated rural clinics in Vermont and New Hampshire. Individualized academic detailing visits were provided to clinicians identified by the informatics tool with the aim of increasing guideline-concordant care. Other educational efforts included traditional, didactic group education on evidence-based PTSD care and the development and dissemination of educational materials for clinicians and patients. Prescribing trends of benzodiazepines, off-label atypical antipsychotics, and prazosin were collected quarterly for 3 years (October 1, 2013, to September 30, 2016). Results: Prescribing rates of benzodiazepines during the educational intervention decreased from 13% to 9.3%. Use of off-label atypical antipsychotics, a class of medications not recommended for PTSD, stayed relatively flat at about 10%. Prescribing of prazosin, a medication recommended for treatment of trauma nightmares, increased from 9.8% to 14.3%. Conclusions: Academic detailing and other educational programming appear to be effective for addressing gaps and lag in quality PTSD care and are associated with a positive trend of decreased benzodiazepine use. Efforts will continue, now with added focus on concurrent use of benzodiazepines and opioids and the use of off-label atypical antipsychotics in rural veterans with PTSD.
机译：背景：临床指南用于监测后应激障碍（PTSD）建议使用苯并二氮杂卓。苯二氮卓和应激障碍均与上瘾有关的风险。退伍军人事务部（VA）规定趋势表明，在带有第四植物的退伍军人的苯二氮卓和温度使用持续使用，特别是在农村地区。作者审查了使用教育干预，以改善农村诊所中应激障碍退伍军人的药理学管理。方法：VA学术细节服务信息工具集在佛蒙特州白河交界处VA医疗中心（WRJ VA）和附属农村诊所，为退休人员提供了处方，人口和风险因素数据，并在佛蒙特州和新罕布什尔州的附属农村诊所。为信息工具确定的临床医生提供个性化的学术探访，其目的是增加指导态度。其他教育努力包括传统，教学基于循证的应激障碍护理和临床医生和患者教育材料的发展和传播。苯二氮卓类药物，非典型非典型抗精神病药和普拉佐汀的规定趋势被季刊（2013年10月1日至2016年9月30日）收集。结果：教育干预期间苯并二氮卓的规定率从13％降至9.3％。使用非标签非典型抗精神病药，一类不推荐用于投灾的药物，保持相对平坦的约10％。 Prazosin的处方，推荐用于治疗创伤噩梦的药物，从9.8％增加到14.3％。结论：学术细节和其他教育方案似乎有效地解决了质量应激障碍的差距和滞后，与苯并二氮杂卓使用的积极趋势有关。努力将继续，现在补充着苯二氮卓和阿片类药物和阿片类药物的同时使用以及在农村退伍军人工地使用非典型非典型抗精神病药。

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