Postpartum Opioid Use among Military Health System Beneficiaries

Objective The aim of the study is to evaluate the prevalence and factors associated with opioid prescriptions to postpartum patients among TRICARE beneficiaries receiving care in the civilian health care system versus a military health care facility. Study Design We evaluated postpartum opioid prescriptions filled at discharge among patients insured by TRICARE Prime/Prime Plus using the Military Health System Data Repository between fiscal years 2010 to 2015. We included women aged 15 to 49 years old and excluded abortive pregnancy outcomes and incomplete datasets. The primary outcome investigated mode of delivery and demographics for those filling an opioid prescription. Secondary outcomes compared prevalence of filled opioid prescription at discharge for postpartum patients within civilian care and military care. Results Of a total of 508,258 postpartum beneficiaries, those in civilian health care were more likely to fill a discharge opioid prescription compared with those in military health care (OR 3.9, 95% CI 3.8–3.99). Cesarean deliveries occurred less frequently in military care (26%) compared with civilian care (30%), and forceps deliveries occurred more frequently in military care (1.38%) compared with civilian care (0.75%). Women identified as Asian race were least likely to fill an opioid prescription postpartum (OR 0.79, 95% CI 0.75–0.83). Women aged 15 to 19 years had a lower odds of filling an opioid prescription (OR 0.83, 95% CI 0.80–0.86). Women associated with a senior officer rank were less likely to fill an opioid prescription postpartum (OR 0.83, 95% CI 0.73–0.91), while those associated with warrant officer rank were more likely to fill an opioid prescription (OR 1.14, 95% CI 1.06–1.23). Conclusion Our data indicates that women who received care in civilian facilities were more likely to fill an opioid prescription at discharge when compared with military facilities. Factors such as race and age were associated with opioid prescription at discharge. This study highlights areas for improvement for potential further studies. Key Points

Approaches to the justification of targeted subsidies for drugs in providing medical care in ambulatory conditions in military medical organizations

This study presents the results of the analysis of the funding mechanisms for drug supply of assigned contingents in the provision of outpatient medical care in military medical organizations. Existing approaches to determining methods for optimizing the need for drugs are considered. In addition, this paper presented approaches to the formation of a formulary list of medicinal products of a military medical organization. This study also showed the possibility of using pharmacoeconomic assessment in justifying targeted subsidies for drug supply. The relevance of the analysis of the assortment structure for entry into the approved list of vital and essential medicines is emphasized. A possible algorithm for substantiating a targeted subsidy for drug supply in the provision of outpatient medical care within the framework of military health care involved eight stages. First, the incidence of attached contingents entitled to drug supply at the expense of the Russian Ministry of Defense for outpatient treatment was analyzed. Second, the nomenclature of medicines was determined by comparing the incidence pattern of attached contingents with the list of medicines presented in the standards of medical care and clinical recommendations. Third, groups of drugs (with specific and wide spectrum of action) normally used are distinguished, considering the uniqueness of consumption when predicting (planning) demand. Fourth, the need for medicines were formulated using the normative method, modeling method, and logicoeconomic and other methods for determining the need, taking into account the peculiarities of their application in medical, social, and economic conditions of the military medical organization. Fifth, the created drug list was optimized based on the combined ABC-VEN analysis. Sixth, the formal list of the military medical organization was optimized by taking into account the results of pharmacoeconomic research on the treatment of specific diseases. Seventh, an analysis of the assortment structure in relation to the list of vital and essential drugs was performed to further substantiate their economic, clinical, and pharmacoeconomic effectiveness. Eighth, a targeted subsidy for drug supply was calculated, and application was filed, which contained calculations of planned costs with the appendix of the list of planned drugs for purchase, as well as commercial proposals justifying its cost.

Optimizing Military Medicine: A Team Approach

ABSTRACT In order to best optimize health care, we need the right combination of individuals working on interprofessional health care teams, each joining with the right mindset, in the right places, and at the right times. In this special issue of Military Medicine, Dr. Lara Varpio and her team share their findings investigating the unique dynamics of Military Interprofessional Healthcare Teams. Such research is fundamental to advance excellence of military health care by finding, exploring, and addressing existing gaps in what we currently employ and capitalizing on what we know works well. In doing so, we can improve the effectiveness of our care teams and, as a result, optimize care of our wounded on the battlefield.

Leadership and Followership in Military Interprofessional Health Care Teams

ABSTRACT Introduction The U.S. Military has long been aware of the vital role effective leaders play in high-functioning teams. Recently, attention has also been paid to the role of followers in team success. However, despite these investigations, the leader-follower dynamic in military interprofessional health care teams (MIHTs) has yet to be studied. Although interprofessional health care teams have become a topic of increasing importance in the civilian literature, investigations of MIHTs have yet to inform that body of work. To address this gap, our research team set out to study MIHTs, specifically focusing on the ways in which team leaders and followers collaborate in MIHTs. We asked what qualities of leadership and followership support MIHT collaboration? Materials and Methods This study was conducted using semi-structured interviews within a grounded theory methodology. Participants were purposefully sampled, representing military health care professionals who had experience working within or leading one or many MIHTs. Thirty interviews were conducted with participants representing a broad range of military health care providers and health care specialties (i.e., 11 different health professions), ranks (i.e., officers and enlisted military members), and branches of the U.S. Military (i.e., Army, Navy, and Air Force). Data were collected and analyzed in iterative cycles until thematic saturation was achieved. The subsets of data for leadership and followership were further analyzed separately, and the overlap and alignment across these two datasets were analyzed. Results The insights and themes developed for leadership and followership had significant overlap. Therefore, we present the study’s key findings following the two central themes that participants expressed, and we include the perspectives from both leader and follower viewpoints to illustrate each premise. These themes are as follows: (1) a unique collaborative dynamic emerges when team members commit to a shared mission and a shared sense of responsibility to achieve that mission; and (2) embracing and encouraging both leader and follower roles can benefit MIHT collaboration. Conclusions This study focused on ways in which team leaders and followers on MIHTs collaborate. Findings focused on qualities of leadership and followership that support MIHT’s collaboration and found that MIHTs have a commitment to a shared mission and a shared sense of responsibility to achieve that mission. From this foundational position of collective responsibility to achieve a common goal, MIHTs develop ways of collaborating that enable leaders and followers to excel to include (1) understanding your role and the roles of others; (2) mutual respect; (3) flexibility; and (4) emotional safety. The study data suggest that MIHT members work along a continuum of leadership and followership, which may shift at any moment. Military interprofessional health care teams members are advised to be adaptive to these shared roles and contextual changes. We recommend that all members of MIHTs acquire leadership and followership training to enhance team performance.

Chest Pain in the Deployed Setting: A Case of Wellens Syndrome

ABSTRACT Managing patients with chest pain in deployed and austere environments can be extremely challenging for military health care providers. Limited resources, including access to equipment, emergent cardiac catheterization, and cardiac surgery, can lead to deleterious consequences, including myonecrosis and possible death. Wellens syndrome is a form of acute coronary syndrome that involves stenosis of the left anterior descending coronary artery, leading to possible acute myocardial infarction. Most cases in the literature involve the diagnosis and treatment of Wellens syndrome in the civilian, nondeployed hospital setting. We present a case of a civilian contractor who had experienced an episode of chest pain that had resolved with rest and now had new findings on electrocardiogram concerning Wellens syndrome.

Army medicine during the First World War

The article explains the development and functioning of an essential military component - medical support wartime - evacuation system. Describes the concept of conservative evacuation, developed in the Russian army at the beginning of the last century, shows the military medical services’ efforts to expand military health care and improve the system of evacuation during World War I. It is noted that, despite significant efforts, the evacua-tion remained the weakest part of Russian military medicine and does not reflect the scale of sanitary losses.

Features of the introduction of an information system for monitoring the movement of medicines in civil and military health care

The features of the introduction of an information system for monitoring the movement of medicines in civil and military health care are considered. It has been shown that in order to counteract the inflow of substandard, falsified and counterfeit medicines to medical and pharmacy organizations, from July 1, 2020, all subjects of their circulation in the Russian Federation are required to enter the necessary information into the automated information system for monitoring the movement of medicines. The preliminary results of the experiment on labeling with control (identification) marks of medicines and monitoring of their circulation are evaluated. It is noted that the introduction of an automated information monitoring system in practice is associated with a number of problems that contribute, in particular, to an increase in the cost of medicines. It was established that in the formation of regulatory mechanisms for monitoring the movement of medicines,the specifics of drug provision in military health care were practically not taken into account, which in turn led to the emergence of a number of legal conflicts. It was revealed that, on the one hand, the obligations to participate in the medicine movement monitoring system have been lifted for the Ministry of Defense, the Federal Security Service, the Foreign Intelligence Service, and, on the other hand, other power ministries and departments must provide the required information to the system. It was emphasized that, given all the problematic issues, the introduction of an information monitoring system has a positive effect on the activities of drug circulation entities, as well as enhancing the effectiveness of drug provision for citizens. It is advisable to provide for separate participation in the information system for monitoring the movement of medicines of the Ministry of Defense and some other power ministries and departments, providing the opportunity, on equal terms with other participants, to confirm the quality of the medicines in circulation.