Ensuring Veterans receive safe, effective, and evidence-based treatments for their mental health problems is a top priority for the Veterans Health Administration (VHA). For many Veterans, this treatment includes the use of psychiatric medications.
Over 1.8 million Veterans currently have an active prescription filled by VA pharmacy for a psychiatric medication, which highlights how important it is to ensure those medications are being used in a manner that maximizes the benefit to Veterans and minimizes potential harms.
We recently reviewed the impact of the Psychotropic Drug Safety Initiative (PDSI), a program that focuses on safe psychiatric medication use across VHA, and I’m pleased to share that the program has had a positive impact on the care provided to Veterans.
First, let me tell you a little bit more about the PSDI program. VHA launched PDSI back in December 2013 in order to foster the highest quality of treatment with medications for Veterans with mental health problems. PDSI is a nation-wide quality improvement (QI) program in which every VHA facility across the country participates.
Metrics of mental health treatment with psychiatric medications
Each facility chooses an area of prescribing on which to focus its local QI efforts and develops their own local plan for improvement. The national PDSI program office supports these local QI efforts by providing data, informatics tools, trainings and educational resources, and feedback and technical assistance. PDSI data include facility and national scores reported quarterly on prescribing metrics that address a variety of aspects of mental health treatment with psychiatric medications.
PDSI informatics tools help facilities identify individual Veterans who might benefit from changes to their current medications. The data in these tools are updated nightly to ensure the most actionable data is shared with facilities every day.
PDSI has also developed trainings for providers and supports the development of educational materials for patients about the safe and effective use of psychiatric medications. PDSI leaders conduct national conference calls twice a month to bring facility workgroups together to share in their success and learn from one another’s challenges.
Program having positive impact on care of Veterans
Since its implementation, the PDSI program has had a robust and positive impact on the care of Veterans. Out of the 20 prescribing metrics tracked in the initial phase of the program, 16 showed improvement in the national score.
There are several areas of prescribing that showed especially strong improvements. Across the system we have decreased use of potentially harmful medications in patients with Posttraumatic Stress Disorder (PTSD), including decreased use of benzodiazepines, antipsychotics and the use of complex, multiple-drug regimens. We have also decreased the use of benzodiazepines among vulnerable populations, such as Veterans with PTSD, dementia, and the elderly, as well as decreased the use of complex, multiple-drug regimens for patients with depression.
We have also successfully increased the use of evidence-based medications for treatment of substance use disorders, particularly in Veterans with alcohol and opioid addiction. These improvements have directly and positively impacted the care of thousands of Veterans.
As the PDSI program moves forward, we are now specifically focusing on ensuring safe, effective use of psychiatric medications among older Veterans. We are confident that the success from our initial efforts will continue, and we are excited to have this opportunity to improve the quality of care we provide our older Veterans.
About the Author: Dr. Ilse Wiechers is the National Program Director for the Psychotropic Drug Safety Initiative in the VA Office of Mental Health Operations and Assistant Professor of Psychiatry at Yale School of Medicine. Dr. Wiechers also provides clinical care to older Veterans in the West Haven VA Medical Center Integrated Primary Care Clinic, specializing in late-life mood, anxiety and trauma-related disorders.
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I live in Montana. The VAH here is excellent! My medical conditions were and are: 1) Back injuries due to Huey shot down in ‘Nam (Sept. 1965) 17 days in country without treatment until USMC “LRP” “grunts” saved my sorry Airedale butt. 2) Heart disease, double by pass open heart surgery 1 1/2 years ago 3) lumbar laminectomy @ L2 – L3, last October 3) repair of torn meniscus 3 years ago 4) Nasal passage overhaul of septum, turbinators and sinuses, which alleviated sleep apnea and eliminated need for CPAP machine 5) PTSD, bipolar which means 4 psychotropics, psychotherapy, Stellate Ganglia Block injections for PTSD. All of these conditions are being professionally handled for me. Even when I was taking Tramadol (550 mg day) my primary VA MD and my psychiatrist were very active in monitoring all aspects of my medication “cocktail.” Forgot to note diabetes and blood pressure management.
So the point is that the VA Health organization here in Montana is doing a stellar job for me. I realize that, as noted by others here they have not had my kind of experience. The only suggestion I can make is that if you can do it move to Montana !
U know when va doc give me some meds resparked pins and needle and burn in 2nd3rd degrees burn I got pill 8 yr ago it still nonstop , try many antidepressants but it give nasty side effect I got a head injury in service!!!!! Most of do give to head injury!!!! I get 60 pill outside doc 2 pils a day help the pin needles, I have migraine thier a new thing but Madison va have no knowledge how to get it, so pass yr my drug were taken away cold , I suffer 1 1/2 va doc did not understand I can’t take antidepressants. So thier DEA rule va can give out drug , I have cc doc monthly renew it don’t give me that shit they can’t, it big brother doctor are puppet today! I got new doc I can’t cc her until Aug health care still suck
It’s easy to say that service is better than the outside clinics. I can’t get medication that could help the serequel and the zoloft with my bi-polar depression. How does that translate into proper care.
These so called experts in the medical field are Full Of Crap. I have been on 2 of the strongest pain meds for now on 15 years. I have an inoperable spine condition. Took 14 years to get my VA doc. to change one of them to a SLIGHTLY stronger medication. I find it a mystery when the documents that come with my meds. state that prolonged use will develop immunity and to discuss with your PCP about raising dosage. When you do they say, “They won’t let me give anything stronger unless you have cancer”. Why should I have to suffer more than a cancer patient??!! These “One size fits all” mentality concerning medication is REDICULOUS! What works for one may not work for another. I even had the Head Of Pharm. tell me that people don’t build tolerances to pain meds. I asked her where the hell she went to school. Just like politicians know NOT how to fight a war, Bureaucrats have no idea how to treat a person’s pain or other medical conditions, for that matter. I feel it is JUST PLAIN WRONG for a bill counter to tell a licensed physician what medications he can give his patients. If the VA doesn’t trust their employed doctors to treat us properly, then HOW THE HELL do they expect US TO TRUST THEIR DOCTORS??????!!!!!!! I will be glad when they find something else to occupy their tiny little brains with, and leave my medical care to my doctor and myself! This OPIOD crap is nothing more than slight of hand to get the public’s attention off the fact that Vets. are STILL DYING while waiting for appointments with VA docs. And NOW more are dying from self medicating because we can’t get pain relief!
I so agree with your statement which says nobody knows what works for me better than I. I was taking off my opiates that I had been on for 15 years, because of the back problems I have. They know I was in pain, so they put me on horrible, strong medications that made me hallucinate, plan a suicide for me and my dog, among other side effects. He tried one and within a week I was in the mental-health ward. I went through withdrawal while I was in the hospital. I love the hospital after week on new medications for my pain. They caused hallucinations, and I was talking to people, I actually thought I heard them talking back to me. Again, there were other side effects as well. I ended back in the hospital for another week. These other drugs actually had worse side effects and addiction problems as the other but the other didn’t cause these problems that put me in the hospital. Something was put into my photo I found out later saying I was the drugs. I thought that meant I was always looking for drugs of any kind. I wasn’t! I was asked if I had ever been told what that meant. I hadn’t, so I looked it up and found out it was someone who is constantly going to different doctors to get drugs. I was never addicted to opiates. I had no problem getting off of them, but it affected my medical care. I went into the choice program, and I was judged and treated like I was trying to get drugs. They sent me to a pain clinic. The doctor said I definitely needed pain medicine. When he got the records from the VA the attitude changed, and he said he won’t give me your narcotics. So he sent me to hydrotherapy. I love being in water, but the second time I went, it was just too much because I didn’t have anything to help me with the pain which got worse, I had to stop going. The PCP that I was going to want to see my records, when she got these records, and I went to my appointment she told me that I have a drug problem, and I told her I hadn’t been using anything almost a year. She actually said, how would anybody know, you haven’t been tested! Then she said I was a drug seeker. I was astonished and flabbergasted. All the sudden I felt like this dirty horrible person that was being treated like I was a drug dealer or I don’t know, I just know I was profound and I was judged, I felt demeaned so dirty. I, also, I have severe PTSD and The treatment I have been given I feel like some heinous person. I left the office in a haste. I was so belittled. I got another choice doctor which made it look even worse. I couldn’t stay with that doctor! The new doctor, after reading the VA records wouldn’t do tests on me, even examine me, he didn’t believe me. Unfortunately, I have several medical problems and depression and this situation has made me even worse, now I am in bed most of the time because of pinch nerves in my back of my neck stenosis and lower back stenosis. I’ve been wanting to move to Costa Rica for over year now. I can’t travel. I have always been active, love the outdoors, and I’m housebound. There are definite times I just want to give up thinking they’re never going to help me. I don’t care what it takes I just need them to repair damaged or in the meantime if they could put me on something so I can live. Hell, I’ll take injections, I’ve tried the laser, the tens unit, i’ll kinds of Joe’s. I just kept getting worse, and nobody paid attention. When they stop giving out opioids, there was a stipulation about not making the patients suffer in severe pain. I’m sorry this goes on, but it does feel good to get this out i’m sorry this goes on, but it does feel good to get this out. Demi so paranoid I’m afraid to even mention pain. I get a look of disgust. So I don’t really know what’s in my Record that it is devastating, and it is ruining my medical care before I even walked in the office. I was going to go to the privacy officer, but she said after they get my letter disputing what is in my record, they ask other staff members. But, as I was told, this is the government records. I doubt very much if anybody’s going to go against an RN. The doctors change so much the patience are bounced all over to different doctors, So there is no steady doctor you could give a reason for her to put this in my record. But that doesn’t matter.
I wholeheartedly agree that mess should not have government interference. It simply does not work whether in the military or private practice. In order to save 75,000 addicts, 9 million others who need to have pain medications for serious treatment end up having to pay the price. I’ve been only OxyContin for 15 years and not once have I abused the taking of this med. I’ve been as high as 8- mg 3X a day and as low as 20 mg. this is what the doctor and I worked on together as my plan of action. When these government officials walk in our shoes then see how and what they want as a pain med (Tylenol or OxyContin).
It took me many years to find a Dr. and a combo of meds that actually work for me. They, the Dr. writes the scripts they feel are needed on p.a. individual basis and should be able to do so without being influenced by other Gov. agecies try to control what they do.
No one knows what I need and what works for me, better than me.
Leave well enough alone and don’t mess with the Dr. Patient relationships.
I agree with Dr. David Hatfields SGM’s comment above.
Well said. Blanket “initiatives ” that overide individual needs, especially over an experts advice, is nuts. Next thing we do is hand out musket balls to bite on for relief.
Dave Engels, or find the weapons to put musket balls in? I throw my hands up to the VA. Just maybe I’ll cross party lines and vote for Trump, he’ll fire them all…
This sounds very similar to the Opioid Drug Safety Initiative the VA, DEA, FDA, and CDC all got together to create where VA physicians were told not to prescribe opioids to veterans anymore, and VA pharmacists were enabled to overrule any VA physicians who dared to actually prescribe any opioids to their patients. This sent Veterans suffering from chronic pain from a variety of different wounds and illnesses either to the streets to die of heroin overdoses or to their closets to end the pain through suicide by handgun.
Just remember, Newton’s Third Law works the same everywhere. To paraphrase: For every overreaction, there is an equal and opposite reaction.
Thank you for saying that, I’m glad a reputable and educated person sees that correlation. It happened to me in a way similar to what your described. For almost 3 years I took the NSAIDS, did physical therapy, did cognitive behavioral therapy, and every other pain management plan to work with their “No narcotics” approach. As the pain got worse, I explained to my doctors that I had left 3 jobs to find more suitable ones for my pain level. They had no response to that, other than “hopefully you’ll find a suitable job.” Next time I said that the pain was too much, and I would have to start taking something to help, just to be able to work,whether it was from them, or elsewhere. Of course they advised against it, but I started taking a strong narcotic that a neighbor gave me (I was helping her with cancer recovery). It worked great and I told the VA doctor about it. It was stronger than what I needed, but it’s all I could find. They gave me a drug test, then flagged me for all medication that have any abuse potential. I stayed on the drug until a non-VA doctor fixed my pain 1 week after my first appointment with him. When I tried quitting the pain meds, I realized that my body was dependent on them. I confessed this to the VA, and they said they didn’t have any program to help me and said I’d have to find another practice to help me get clear of them. I eventually did, and of course I have to pay for it.
I tried being honest with the VA, and all they did was use it against me, and refuse to help when I asked for it. Had they given me a mild pain medication, and monitored it, I wouldn’t have sought out my own medications and gotten addicted to a very strong opiate. I understand they want to avoid addiction, but their approach backfired on me.
I have learned that with the chronic pain that I suffer from #1 my back from the military and #2 Fibromyalgia can not be solved with fish oil. The VA will not admit it but trauma can cause the fibromyalgia, the military was my dream since I was about 8 or 9 years old, hurting my back was a traumatic event in my life it actually ruined my life and my dreams were crushed. It is 2 in the morning normal people would be sleeping I can’t, if I lie down to long my back hurts so bad I have had to crawl to the shower before just to let the hot water hit me long enough to loosen up so I can stand up. Now, with the fibro my body hurts so bad, I do not like people touching me, my hands hurt they cramp up to the point I am having difficulty performing my job. I work 40 hours a week in addition to walking yes exercise daily with my dog, I keep trying to figure out how I can retire but it is kind of hard when you look at welfare would not even pay for living quarters much less food. The VA will not acknowledge the two are hand in hand in addition I have CFS, I use a cane because my left side keeps giving out, but the VA will not recognize it, I have incontinence, the VA will not even address the issue I have been to 2 C & P exams they put what they want in the comments and will not recognize the fact I am having difficulty getting around. I have to live with pain on a daily basis they say the Duloxetine will help with the fibromyalgia pain very little but it does help with the depression. So what do I take for pain the amount of ibuprofen is probably going to kill my insides and at best it does not get rid of the pain it may take a pain scale of 10 to a 9, hey I take what I can get. Who needs pain meds that is why they are made. I went to the ER at the local VA because my back was hurting so bad and I had been at the VA for several hours in addition to 1 ½ drive to the VA, nurse came in asked what was wrong, next the “doctor” and that term is used loosely accused me of wanting hard drugs for pain I did not ask for anything I just was hoping they would do like they had in the past a shot of toradol to help with the1 ½ hour drive back, I have times I can’t lean back in a chair because my spine hurst so bad. Yes I filed a complaint with the medical board on her. She stood in the doorway with yellow stick it note pad full of accusations and not once discussing anything with me. But it is ok, we Veterans have learned to live with pain, wish I had a voodoo doll so the doctors can experience the pain that I have and then give them fish oil and send them on their way.
Thank you