Round | Examples of disagreement | Guideline author's reasoning | Revisions made in response |
---|---|---|---|
Round one | Strict discontinuation messages based on substance abuse or psychiatric diagnosis | Need to evaluate current status of diagnosis | Updated algorithm to generate all therapeutic options with contraindications for provider to consider and apply based on clinical judgement |
Round one | Warning for patients that live >200 miles from VA. | Patients may have continuity of care even if living far away. | Recommendation to not provide opioid therapy and refer patient for care with a local provider was removed |
Round two | Dose recommendation for short acting opioids combined with NSAIDs/acetaminophen | Concern about dose of NSAIDs/acetaminophen with medication combinations | Wording of message updated |
Round two | Warning about patients with personality disorder | Warn specifically about anti-social and borderline personality disorders | Restricted warnings to persons with these specific personality disorder diagnoses. |