{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:17:37Z","timestamp":1787019457719,"version":"build-2736575974"},"reference-count":80,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T00:00:00Z","timestamp":1713398400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Veterans Affairs (VA) Puget Sound Research and Development Service"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Use &amp;amp; Addiction Journal"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The Veterans Health Administration (VA) implemented academic detailing (AD) to support safer opioid prescribing and overdose prevention initiatives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patient-level data were extracted monthly from VA\u2019s electronic health record to evaluate whether AD implementation was associated with changes in all-cause mortality, opioid poisoning inpatient admissions, and opioid poisoning emergency department (ED) visits in an observational cohort of patients with long-term opioid prescriptions (\u226545-day supply of opioids 6\u2009months prior to a given month with \u226415\u2009days between prescriptions). A single-group interrupted time series analysis using segmented logistic regression for mortality and Poisson regression for counts of inpatient admissions and ED visits was used to identify whether the level and slope of these outcomes changed in response to AD implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 955\u2009376 unique patients (19\u2009431\u2009241 person-months), there were 53\u2009369 deaths (29\u2009025 pre-AD; 24\u2009344 post-AD), 1927 opioid poisoning inpatient admissions (610 pre-AD; 1317 post-AD), and 408 opioid poisoning ED visits (207 pre-AD; 201 post-AD). Immediately after AD implementation, there was a 5.8% reduction in the odds of all-cause mortality (95% confidence interval [CI]: 0.897, 0.990). However, patients had a significantly increased incidence rate of inpatient admissions for opioid poisoning immediately after AD implementation (incidence rate ratio\u2009=\u20091.523; 95% CI: 1.118, 2.077). No significant differences in ED visits for opioid poisoning were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>AD was associated with decreased all-cause mortality but increased inpatient hospitalization for opioid poisoning among patients prescribed long-term opioids. Mechanisms via which AD\u2019s efforts influenced opioid-related outcomes should be explored.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29767342241243309","type":"journal-article","created":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T05:29:16Z","timestamp":1713418156000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Implementation of Opioid Safety Efforts: Influence of Academic Detailing on Adverse Outcomes Among Patients in the Veterans Health Administration"],"prefix":"10.1177","author":[{"given":"Emily C.","family":"Williams","sequence":"first","affiliation":[{"name":"Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA"},{"name":"Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5878-7692","authenticated-orcid":false,"given":"Madeline C.","family":"Frost","sequence":"additional","affiliation":[{"name":"Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA"},{"name":"Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bounthavong","sequence":"additional","affiliation":[{"name":"Academic Detailing Service, Pharmacy Benefits Management, Veterans Health Administration, Department of Veterans Affairs Central Office, Washington, DC, USA"},{"name":"VA Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA"},{"name":"UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy T.","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA"},{"name":"Mathematica, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos K.","family":"Lau","sequence":"additional","affiliation":[{"name":"Academic Detailing Service, Pharmacy Benefits Management, Veterans Health Administration, Department of Veterans Affairs Central Office, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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