Journal of general internal medicine
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Interventions and research to address the US opioid crisis have, for the most part, targeted opioid use, misuse, and addiction specifically. While such a focus can lead to useful innovations in the care of opioid use disorder, the fact that many persons with opioid use disorder use multiple substances (both over their life course and simultaneously in drug-using episodes) makes it imperative to address broader issues of addiction in persons who have opioid use disorder as their presenting concern. ⋯ Research at the VA does not need to duplicate efforts supported by other funders but can complement such work by providing an integrated platform for determining the best approaches to implementing innovations. The real-world learning health system that has been developed in the VA is poised to contribute in just such important ways.
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Letter Observational Study
US Physicians with Recent Experience Managing Hospitalized Older Adults: an Observational Study.
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Editorial
Promoting Patient-Centeredness in Opioid Deprescribing: a Blueprint for De-implementation Science.
A downward trend in opioid prescribing between 2011 and 2018 has brought per-capita opioid prescriptions below the levels of 2006, the earliest year for which the Centers for Disease Control and Prevention has published data. That trend has affected roughly ten million patients who previously received long-term opioid therapy. Any effort to reduce or replace a prior health practice is termed de-implementation. ⋯ It can deepen our understanding of how policies are chosen, communicated, and carried out. Policymakers and researchers who embrace this framework will need a better approach to measuring success and failure in health care where both pain and opioids are concerned. This would involve shifting from a reductive focus on opioid prescription counts toward measures that are more effective, holistic, and patient-centered.