2024
The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline.
Schnurr P, Hamblen J, Wolf J, Coller R, Collie C, Fuller M, Holtzheimer P, Kelly U, Lang A, McGraw K, Morganstein J, Norman S, Papke K, Petrakis I, Riggs D, Sall J, Shiner B, Wiechers I, Kelber M. The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Annals Of Internal Medicine 2024, 177: 363-374. PMID: 38408360, DOI: 10.7326/m23-2757.Peer-Reviewed Original ResearchConceptsClinical practice guidelinesU.S. Department of Veterans AffairsDepartment of Veterans AffairsVeterans AffairsPosttraumatic stress disorderManagement of posttraumatic stress disorderAcute stress disorderExternal group of expertsPractice guidelinesDefense Clinical Practice GuidelinesStress disorderPatient-centered careIndividual health outcomesRevised CPGDepartment of Defense Clinical Practice GuidelinesVideo teleconferencingStrength of evidenceQuality of lifeCo-occurring conditionsHealth outcomesPatient perspectiveEvidence-basedPosttraumatic stress disorder treatmentSystematic searchCognitive processing therapy
2022
The Management of Major Depressive Disorder: Synopsis of the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline.
McQuaid JR, Buelt A, Capaldi V, Fuller M, Issa F, Lang AE, Hoge C, Oslin DW, Sall J, Wiechers IR, Williams S. The Management of Major Depressive Disorder: Synopsis of the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Annals Of Internal Medicine 2022, 175: 1440-1451. PMID: 36122380, DOI: 10.7326/m22-1603.Peer-Reviewed Original ResearchMeSH KeywordsDepressive Disorder, MajorHumansUnited StatesUnited States Department of Veterans AffairsVeteransConceptsClinical practice guidelinesMajor depressive disorderVeterans AffairsDepressive disorderPractice guidelinesDefense Clinical Practice GuidelineJoint clinical practice guidelineManagement of MDDTrustworthy clinical practice guidelinesUse of telemedicineMedicine's tenetsPharmacologic managementGuideline panelAlternative therapiesGRADE systemKey recommendationsPrior recommendationsClinical stakeholdersImportant new evidenceDisordersSelect recommendationsDepartmentGuidelinesManagementRecommendationsEffect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder
Oslin DW, Lynch KG, Shih MC, Ingram EP, Wray LO, Chapman SR, Kranzler HR, Gelernter J, Pyne JM, Stone A, DuVall SL, Lehmann LS, Thase ME, Aslam M, Batki S, Bjork J, Blow F, Brenner L, Chen P, Desai S, Dieperink E, Fears S, Fuller M, Goodman C, Graham D, Haas G, Hamner M, Helstrom A, Hurley R, Icardi M, Jurjus G, Kilbourne A, Kreyenbuhl J, Lache D, Lieske S, Lynch J, Meyer L, Montalvo C, Muralidhar S, Ostacher M, Paschall G, Pfeiffer P, Prieto S, Przygodzki R, Ranganathan M, Rodriguez-Suarez M, Roggenkamp H, Schichman S, Schneeweis J, Simonetti J, Steinhauer S, Suppes T, Umbert M, Vassy J, Voora D, Wiechers I, Wood A. Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder. JAMA 2022, 328: 151-161. PMID: 35819423, PMCID: PMC9277497, DOI: 10.1001/jama.2022.9805.Peer-Reviewed Original ResearchConceptsMajor depressive disorderPatient Health Questionnaire-9Usual care groupUsual carePharmacogenomic testingDrug-gene interactionsRemission rateMedication selectionCare groupDepressive disorderVeterans Affairs Medical CenterActive substance use disorderCo-primary outcomesPrescription of medicationsBetter clinical outcomesProportion of prescriptionsRemission of symptomsSubstance use disordersEligible patientsWeek 24Effective antidepressantSingle antidepressantClinical outcomesInitial treatmentQuestionnaire-9Comparison of mental health outcomes of augmenting medications for patients with posttraumatic stress disorder: A national veterans affairs study
Ranney R, Maguen S, Woods A, Seal K, Neylan T, Bernardy N, Wiechers I, Ryder A, Cohen B. Comparison of mental health outcomes of augmenting medications for patients with posttraumatic stress disorder: A national veterans affairs study. Journal Of Evaluation In Clinical Practice 2022, 29: 191-202. PMID: 35709244, DOI: 10.1111/jep.13726.Peer-Reviewed Original ResearchConceptsEmergency room visitsPosttraumatic stress disorderPsychiatric emergency room visitsAugmenting medicationsRoom visitsMental health outcomesPsychiatric hospitalizationHospitalization/emergency room visitsHealth outcomesStress disorderPTSD symptomsVeterans Affairs studyDiagnosis of PTSDMedication groupClinical trialsAdditional interventionsMedicationsBaseline levelsPatientsVeterans AffairsNew prescriptionsElectronic recordsVisitsHospitalizationSymptomsEvaluation of Antipsychotic Reduction Efforts in Patients With Dementia in Veterans Health Administration Nursing Homes
Gerlach LB, Maust DT, Kales HC, Chang M, Kim HM, Wiechers IR, Zivin K. Evaluation of Antipsychotic Reduction Efforts in Patients With Dementia in Veterans Health Administration Nursing Homes. American Journal Of Psychiatry 2022, 179: 544-552. PMID: 35615813, PMCID: PMC9349465, DOI: 10.1176/appi.ajp.21060591.Peer-Reviewed Original ResearchConceptsVeterans Health AdministrationCNS-active medicationsVHA Nursing HomesNursing homesAnxiolytic prescribingOverall prescribingVeterans Health Administration nursing homesNursing home patientsNursing home residentsInterrupted time series designAntipsychotic reductionQuarterly prevalenceMedication classesOpioid medicationsAntidepressant prescribingAntipsychotic useMedication prescribingHome patientsPsychotropic medicationsLabel useHome residentsSimilar riskMedicationsPrescribingHealth Administration
2021
Benzodiazepine Prescribing from VA and Medicare to Dually Enrolled Older Veterans: A Retrospective Cohort Study
Lei L, Strominger J, Wiechers IR, Kim HM, Blow FC, Bohnert ASB, Min L, Krein SL, Maust DT. Benzodiazepine Prescribing from VA and Medicare to Dually Enrolled Older Veterans: A Retrospective Cohort Study. Journal Of General Internal Medicine 2021, 36: 3689-3696. PMID: 34047924, PMCID: PMC8642498, DOI: 10.1007/s11606-021-06780-y.Peer-Reviewed Original ResearchConceptsBZD prescriptionOlder veteransBZD prescribingHigher oddsPart DVeterans Affairs Health Care SystemRetrospective cohort studyPart D coverageMedicare Part D prescriptionsSubstance use disordersHealth care systemDesignRetrospective cohortPrescription prevalenceQuarterly prevalenceBenzodiazepine prescribingPart D prescriptionsCohort studyPatient characteristicsBZD useUse disordersFacility variationOlder agePrescribingBZDCare systemTrends in Medication Prescribing in Patients With PTSD From 2009 to 2018: A National Veterans Administration Study.
Holder N, Woods A, Neylan TC, Maguen S, Seal KH, Bernardy N, Wiechers I, Ryder A, Urbieta AM, Cohen BE. Trends in Medication Prescribing in Patients With PTSD From 2009 to 2018: A National Veterans Administration Study. The Journal Of Clinical Psychiatry 2021, 82 PMID: 34004087, DOI: 10.4088/jcp.20m13522.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAntipsychotic AgentsDrug PrescriptionsHumansLongitudinal StudiesMaleMiddle AgedPractice Patterns, Physicians'Psychotropic DrugsRetrospective StudiesSelective Serotonin Reuptake InhibitorsSerotonin and Noradrenaline Reuptake InhibitorsStress Disorders, Post-TraumaticUnited StatesUnited States Department of Veterans AffairsVeteransConceptsPosttraumatic stress disorderPercentage of patientsVeterans Health AdministrationVHA careAdjunctive medicationsOutpatient prescription recordsSSRIs/SNRIsVeterans Administration studyClinical practice guidelinesICD-10 codesAdverse side effectsEvidence-based psychotherapiesPsychotic spectrum disordersAAP useMedication classesBenzodiazepine prescriptionsMedication prescribingPrescription recordsSymptom improvementNational cohortPractice guidelinesMedicationsSide effectsICD-9Patients
2020
Benzodiazepine Use among Medicare, Commercially Insured, and Veteran Older Adults, 2013–2017
Maust DT, Kim HM, Wiechers IR, Ignacio RV, Bohnert ASB, Blow FC. Benzodiazepine Use among Medicare, Commercially Insured, and Veteran Older Adults, 2013–2017. Journal Of The American Geriatrics Society 2020, 69: 98-105. PMID: 32951209, PMCID: PMC7856043, DOI: 10.1111/jgs.16825.Peer-Reviewed Original Research
2018
Patient centered medical homes did not improve access to timely follow-up after ED visit
Chou SC, Rothenberg C, Agnoli A, Wiechers I, Lott J, Voorhees J, Bernstein SL, Venkatesh AK. Patient centered medical homes did not improve access to timely follow-up after ED visit. The American Journal Of Emergency Medicine 2018, 36: 854-858. PMID: 29452920, DOI: 10.1016/j.ajem.2018.01.070.Peer-Reviewed Original ResearchConceptsPrimary care followPrimary care practicesPCMH designationCare followAffordable Care ActAppointment availabilityCare practicesEmergency department dischargeGreater New HavenED visitsED patientsTimely followInsurance statusOutpatient practiceInsurance typeHours appointmentED diagnosisMedical homeLocal cliniciansPractice characteristicsSignificant associationPatientsFollowStandardized scriptPractice improvement
2017
National Trends in Antidepressant, Benzodiazepine, and Other Sedative-Hypnotic Treatment of Older Adults in Psychiatric and Primary Care.
Maust DT, Blow FC, Wiechers IR, Kales HC, Marcus SC. National Trends in Antidepressant, Benzodiazepine, and Other Sedative-Hypnotic Treatment of Older Adults in Psychiatric and Primary Care. The Journal Of Clinical Psychiatry 2017, 78: e363-e371. PMID: 28448697, PMCID: PMC5408458, DOI: 10.4088/jcp.16m10713.Peer-Reviewed Original ResearchConceptsPrimary care providersPrimary carePain diagnosisCare providersOlder adultsClinical characteristicsNational Ambulatory Medical Care SurveyNon-Hispanic white patientsAmbulatory Medical Care SurveyMental healthCommon psychotropic medicationsOutpatient physician visitsPrimary care visitsUse of antidepressantsMental health treatmentCare visitsMedication usePhysician visitsWhite patientsPsychotropic medicationsCare SurveyPsychotropic useHealth treatmentVisit ratesAntidepressantsDevelopment and Applications of the Veterans Health Administration’s Stratification Tool for Opioid Risk Mitigation (STORM) to Improve Opioid Safety and Prevent Overdose and Suicide
Oliva EM, Bowe T, Tavakoli S, Martins S, Lewis ET, Paik M, Wiechers I, Henderson P, Harvey M, Avoundjian T, Medhanie A, Trafton JA. Development and Applications of the Veterans Health Administration’s Stratification Tool for Opioid Risk Mitigation (STORM) to Improve Opioid Safety and Prevent Overdose and Suicide. Psychological Services 2017, 14: 34-49. PMID: 28134555, DOI: 10.1037/ser0000099.Peer-Reviewed Original ResearchConceptsVeterans Health AdministrationSuicide-related eventsPredictive risk modelAdverse eventsRisk factorsRisk mitigation interventionsOpioid-related adverse eventsVHA electronic medical recordsSuicide-related adverse eventsOpioid risk mitigationOpioid Safety InitiativeHigh-risk patientsNaloxone distribution programsElectronic medical recordsOpioid prescribingOpioid analgesicsVHA patientsStratification toolMedical recordsOverdose educationPatientsHealth AdministrationMortality dataPatient identificationRisk model
2016
No End in Sight: Benzodiazepine Use in Older Adults in the United States
Maust DT, Kales HC, Wiechers IR, Blow FC, Olfson M. No End in Sight: Benzodiazepine Use in Older Adults in the United States. Journal Of The American Geriatrics Society 2016, 64: 2546-2553. PMID: 27879984, PMCID: PMC5173408, DOI: 10.1111/jgs.14379.Peer-Reviewed Original ResearchConceptsMental health diagnosesBenzodiazepine useBenzodiazepine usersOlder adultsNonpsychiatrist physiciansNational Ambulatory Medical Care SurveyVisit ratesAmbulatory Medical Care SurveyAnnual visit rateHealth diagnosisEffective alternative treatmentCross-sectional analysisPatient ageOutpatient encountersClinical mental health diagnosisCare SurveyVisit characteristicsChronic usersAlternative treatmentYoung adultsVisitsDecades of evidenceOverall proportionAdultsSafety concernsPrevalence and correlates of coprescribing anxiolytic medications with extensive prescription opioid use in Veterans Health Administration patients with metastatic cancer.
Barry DT, Sofuoglu M, Kerns RD, Wiechers IR, Rosenheck RA. Prevalence and correlates of coprescribing anxiolytic medications with extensive prescription opioid use in Veterans Health Administration patients with metastatic cancer. Journal Of Opioid Management 2016, 12: 259-68. PMID: 27575827, DOI: 10.5055/jom.2016.0341.Peer-Reviewed Original ResearchConceptsPrescription opioid useVeterans Health Administration patientsOpioid useMetastatic cancerAnxiolytic medicationMedical indicationsMultivariate analysisMore emergency department visitsNational VHA dataEmergency department visitsPrescription of antidepressantsAnxiolytic prescriptionsOpioid prescriptionsDepartment visitsVHA patientsPsychotropic medicationsFiscal year 2012VHA dataDrug AdministrationMedicationsBipolar disorderCareful monitoringYounger ageAnxiolyticsCancer
2015
Growing Use of Mental and General Health Care Services Among Older Veterans With Mental Illness
Wiechers IR, Karel MJ, Hoff R, Karlin BE. Growing Use of Mental and General Health Care Services Among Older Veterans With Mental Illness. Psychiatric Services 2015, 66: 1242-1244. PMID: 26278225, DOI: 10.1176/appi.ps.201400370.Peer-Reviewed Original ResearchConceptsHealth care servicesOlder veteransElectronic medical recordsMental illnessCare servicesMedical recordsVeterans Health Administration electronic medical recordsVHA electronic medical recordsGeneral health care servicesVeterans ages 65Health service utilizationMental health needsService utilizationService useHealth needsAge 65IllnessVeteransNational dataProportionPrevalence and correlates of co-prescribing psychotropic medications with long-term opioid use nationally in the Veterans Health Administration
Barry DT, Sofuoglu M, Kerns RD, Wiechers IR, Rosenheck RA. Prevalence and correlates of co-prescribing psychotropic medications with long-term opioid use nationally in the Veterans Health Administration. Psychiatry Research 2015, 227: 324-332. PMID: 25863822, DOI: 10.1016/j.psychres.2015.03.006.Peer-Reviewed Original ResearchMeSH KeywordsAdultAnti-Anxiety AgentsAntidepressive AgentsDrug PrescriptionsFemaleHumansHypnotics and SedativesMaleMental DisordersOpioid-Related DisordersPrevalencePsychotropic DrugsSleep Initiation and Maintenance DisordersUnited StatesUnited States Department of Veterans AffairsVeteransVeterans HealthConceptsMental health clinicsPsychotropic medicationsOpioid prescriptionsHealth clinicsMedical indicationsAnxiolytics/sedatives/hypnoticsLong-term opioid useSpecialty mental health clinicsService use correlatesRelated adverse eventsSedative/hypnoticsVeterans Health AdministrationMental health treatmentAdverse eventsOpioid useHarmful side effectsFiscal year 2012More psychotropicsSide effectsPsychiatric diagnosisHealth treatmentMedicationsHealth AdministrationPsychotropicsAnxiety disorders
2013
Increased Risk Among Older Veterans of Prescribing Psychotropic Medication in the Absence of Psychiatric Diagnoses
Wiechers IR, Kirwin PD, Rosenheck RA. Increased Risk Among Older Veterans of Prescribing Psychotropic Medication in the Absence of Psychiatric Diagnoses. American Journal Of Geriatric Psychiatry 2013, 22: 531-539. PMID: 24211029, DOI: 10.1016/j.jagp.2013.10.007.Peer-Reviewed Original ResearchConceptsPsychotropic medicationsPsychiatric diagnosisOlder veteransNational VHA administrative dataAge groupsOverall medical comorbidityVHA administrative dataLogistic regression analysisDiabetes medicationsMedical comorbiditiesVHA patientsEncounter claimsMedicationsMedical indicationsMental illnessMultivariate analysisMental healthcareFiscal year 2010Unnecessary useDiagnosisIncomplete documentationVeteransHIVStrongest predictorRegression analysis