VIONE changes the way VA handles prescriptions

The VIONE methodology is deprescribing medication at 45 VA facilities and growing


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V-I-O-N-E. These five letters can change a Veteran’s life.

For many Veterans, taking a variety of medications is a necessity. But the simultaneous use of multiple medications—known as polypharmacy—can lead to dangerous drug interactions, adverse outcomes, and challenges with a patient’s ability to adhere to the proper schedule and dosage. In fact, polypharmacy ranks among the top 10 common causes of death in the U.S.

VIONE is a simple, user friendly medication management methodology used to reduce polypharmacy and improve patient safety, comfort, and medication adherence consistent with high-reliability organizations.

VIONE Description

Clinicians and pharmacists use the VIONE acronym to determine if a Veteran’s medications are actively supporting their health care goals:

  • Vital: Is this medication vital to the patient’s health?
  • Important: How important is this medication to the patient’s quality of life?
  • Optional: By taking this medicine, do the benefits outweigh the risks?
  • Not indicated: Is the patient taking medications that are no longer needed?
  • Every medication has a reason: Does every medication support a clear diagnosis or indication?

Developed by VA

VIONE was developed by Dr. Saraswathy Battar, Associate Chief of Staff for Geriatrics and Extended Care Services at Central Arkansas Veterans Healthcare System. It has has successfully impacted the lives of over 77,000 Veterans by deprescribing 168,000 medications and yielding more than $5.8 million in annualized cost avoidance by ensuring Veterans are only taking the medications they need.

Dr. Battar experienced a positive outcome of VIONE in her own facility: “One of our Veterans in the dementia unit had been non-conversant, non-interactive, and non-ambulatory for years. Through the VIONE approach, the pharmacist and clinicians worked together and deprescribed several of his medications over six months. He eventually woke up singing, walking, lucid, and joyful. It was like seeing a miracle unfold in front of my eyes.”

The program, supported by the Veterans Health Administration Innovation Ecosystem’s (VHA IE) Diffusion of Excellence, is now spreading throughout VHA and moving into the private sector and has even been recognized by Congressmen French Hill (R-AR).

This is just one of the many programs supporting VHA IE’s mission to enable the discovery and spread of health care innovations within VHA that exceed expectations, restore hope, and build trust within the Veteran community.

For more information about VHA IE, visit https://www.va.gov/INNOVATIONECOSYSTEM/home.html.

Author

Matthew Razak

Matthew Razak supports VA as a contractor with Atlas Research, a Washington, D.C.-based consulting firm providing strategic advisory and applied research services to federal health and social service agencies. Matt has been working with VA for the past six years supporting social media and communication efforts.

Comments

  1. Robin Edwards    

    I recently wrote to the VA IGO regarding Med refills and timing. We do not have a VA pharmacy at our clinic, or I can drive 100mi. My problem was meds that are only allowed to be filled 30 days at a time we’re not arriving on time and require a signature. These are not meds that are not supposed to be abruptly stopped yet I was going 31-34 days btwn refills. I’ve been told as soon as you receive the Med, put in for your next refill. Problem begins with myhealthevet manipulates dates, then you rely on the VA pharmacy to process it in a timely manner, pass it off to the mail order pharmacy in a timely manner, their processing time, then pass it off to the post office, then depend on the day of the week, then mail carrier to actually come to your door and you have to sit at home 1x every 30 days to get your meds. All my complaints were found to be substantiated! All they did was put a note in my pharmacy file that I’m allowed to call directly and they ship them overnight, it still gets jacked every month. I have to start calling 3 days in advance just to call everyday and make sure it’s being sent and get the tracking number. This month I was going out of town leaving Saturday I started calling on Wednesday, multiple phone calls, fast-forward to Friday afternoon on a holiday weekend they call to give me a tracking number at 1600 and informed me they can’t overnight for Saturday delivery. So it will be Monday or I can come pick it up, WTH? It’s 100 miles and you’ll be closed WHY??? If all my complaints were found to be substantiated and they still can’t get it right or fix it for other veterans

  2. Shauna Pittman    

    Unfortunately, due to massive overuse and abuse of opioids, the pendulum has swung back in the other direction and made it difficult for doctors to prescribe and patients to receive opioids.. Though there are a lot of people that really didn’t/don’t need them (and have had negative effects from opioids such as tolerance to the effects), there are others for whom there are no other options to manage pain and improve functional ability. I suffered for years with chronic back pain that became unbearable and landed me in a wheelchair. Thankfully I finally had successful back surgery (and was given enough pain medicine to tolerate the post-op pain). Now, I only occasionally take acetaminophen or naproxen. I know I am the exception, but I am grateful my doctors knew me well enough to have given me opioids when I really needed them. As a pharmacist, I do hope that our country can find a BALANCE in this crazy situation, and pour resources into helping those with addiction and mental health concerns.

  3. Randy L. Cox    

    I always see and hear about all of the great new changes in the VA Medical programs and that is GREAT! But here in Northern Arizona how is it possible that the VA Medical Care steadily keeps NOT IMPROVING!?! I mean it’s seriously patient neglect beyond belief! New policy this and seamless policies to get you the care when you need it and where you need it! I’m still dealing with the credit bureaus for tens of thousands of dollars not yet paid for from my open heart surgeries over a year and a half ago. My medical team NEVER returns my phone calls forcing me to, after 4 days of calling them, go to the Emergency room and straight to open heart surgeries. And because I had to go to the emergency room the First Choice Program wouldn’t pay one red cent telling me they only pay for planned Dr. visits. My heart medications are ALWAYS late as they are 3-4 weeks late now. I call and order the medications and a week and a half later I call to ask where they are and I’m told that they are not ordered yet. EVERY TIME TOO! It’s gotten worse here at the Northern Arizona VA!

  4. Abbey Williams    

    I was in the Navy. When I got out after 6 years both my knees were shot. At some point I went and was evaluated and there was only pain meds I could use for any relief for pain day and night for years. They were mild opiods. Eventually I started on over the counter because they were not addictive. They were ibuprofen, and then alot of naproxen or aleve. 30 years later tecnology was such that knees could be repaired or replaced. I had the knees replaced. And for along time after I had colon and then kidney cancer. My only respite now due to the knees ache again day and night for reasons not known to me are opiods. Guess what the va does not want to do opiods despite what I have to use for pain relief. I am back to taking large doses of nsaids along with opiods to get thru the days and nights. That i do knowing they can cause or help cause my internal cancers. I have had my thyroid removed for cancer as well. I don’t have alot of answers but can’t really understand why after so many years of pain I had to get my knees replaced by my outside doctors and pain management done outside even today because I have been told that outside pain management would do more for me than the va would. Fortunately I had and have health insurance for that issue. I Don’t think the double standard should exist. Pain doesn’t care who has it no matter if it is the va or other health insurance that helps a patient.
    I should not opt to risk more internal damage by using anti-inflamatories along with opiods to control pain. That is the issue CONTROL!

  5. PAUL G BECK    

    Well, sounds like Dr. Battar, in AR, has sealed her employment! How about Veteran care? I recently found out that a prescription from a non-VA Dr. was denied due to not meeting VA’s criteria…what the hell does that mean? And to top it off I had to research as to why it was taking so long to get the prescription. I was told the prescription had to be “formulated”, again…what the hell does that mean? I was also told this “formalation” process would take 30 days….it’s been six (6) months, I just found out today about the denial…??? Has anyone noticed that now the VA seems to have the need for two, three and even four individuals to handle one out-patient veteran? Sounds like a democrat’s plan to re-distribute the wealth by saving money on materials so this same money could employ more peoples that are not needed! Shameful VA actions. Borderline “Medical Neglect” for thousands of veterans…..
    Welcome home to all my veteran BROTHERS! And…….Semper Fi….

  6. Phillip D Krause    

    When are they ( The VA) going to start working on getting prescriptions that are ordered at a CBOC to the person in less than 5 days? The outside world can go and get them filled the same day.

  7. Ralph M. Maddox    

    In my opinion one of the worst practices is prescribing Off Label, so many medications. They wont give you a sleeping pill so they go Off Label and prescribe some random medication that just so happens to mske you drowsy. Also giving higher dose and have to break in half or quarters. I have often wondered that when i cut the pill , am i getting the same dose. Who knows how much binder vs medication got in this half as oposed to That half. Just q thought.

  8. Ron DiLeo    

    All they are interested in is saving money who are they kidding

    1. Eugene C Berney    

      I know that feeling as they gave me a script of pills that said something about for itching and stuff–did not help in sleeping–I asked the quack that was supposed to be my Dr and he said to get something stronger that worked I would have to go to mental health–what a crock of shit–to this day I still suffer from insomnia–the bullshit pills I now have I might be able to sleep for 2 hours then it’s hello I’m wide awake

    2. Shauna Pittman    

      Yes, VIONE should save the VA money. As a clinical pharmacist, I have been doing this for years in my positions in Military healthcare. Unfortunately in the US, medications get added by different doctors over the years, and doctors that are new to the case can hesitant to make changes (“upset the apple cart” or offend their peers). It takes more money on the front end to have the MANPOWER and TIME to carefully change medication regimens (decreasing or discontinuing one may alter effects of others), and to observe a person’s response to the changes. The cost savings of stopping or decreasing a med is insignificant relative to the savings from decreasing adverse effects and interactions which cost the US BILLIONS annually from ER and hospitalizations. Most significantly, the patient that has their medication regimen carefully evaluated and adjusted should have better healthcare outcomes overall. Isn’t that what we all want?

  9. Robert E. Feffer    

    Why? I only spoke the truth!

  10. Robert E. Feffer    

    Perfect protection.

    I wish the VA would next consider not charging co/pay for vets making over $17,000 annually.

    Not so much for me even though where I live for extra help I am considered low income, more the vets that have given a leg, arm, sight or whatever.

    To me that’s a disgrace!

    I
    Might end by saying the care I get from the doctors is 99% outstanding !

  11. David Uehling    

    How many VA’s are participating in VIONE?

    Thank you

  12. Timothy R Murphy    

    That VIONE sounds to good to be true since VA policy give the vet a pill to satisfy them ! Intelligent veterans won’t take allot of their prescriptions do to it just a pen is a panacea and not addressing the cause! I strongly recommend that the pharmacy use a computer program to delete certain scripts that are basically the same as two scripts! This will protect the veteran and protect the Doctor from a bad script! Both the pharmacy and the doctors need some sort of AI to cover their buttocks! Both have limited time to do prolong thinking or they just do what is Advised by VA system or a pharmacy Rep!
    Thank you for hearing me out!

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