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.