Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

Abstract

Aims To summarise the effectiveness of interventions on appropriate opioid use for noncancer pain among hospital inpatients. Methods Two reviewers independently searched 6 databases up to March 2018 original research articles reporting on quantitative outcomes of interventions on appropriate opioid use among hospital inpatients. Appropriate opioid use was measured by changes in prescribing, such as the lowest effective opioid dose and duration, or clinical outcomes such as adequate pain control. Quality and intervention complexity assessments were performed by 2 independent reviewers. The full methodological approach was published on PROSPERO (ID: CRD42019145947). Results Of 398 full‐text articles assessed for eligibility, 37 articles were included in the review. Most articles had a moderate or high risk of bias (27 of 37 studies). Thirty‐one articles primarily addressed appropriate opioid use and 6 articles targeted opioid safety as a secondary outcome. A multifaceted approach was the most common primary intervention (16 studies) and adequate pain control was the main outcome measured (14 studies). Health provider education, reinforced by hard‐copy material and feedback, was associated with a 13.0 to 29.5% increase in the proportion of opioid prescriptions written in concordance with local guidelines and reduced pain scores ranging from 7.0 to 34.5%. Interventions to improve opioid safety in patient‐controlled analgesia reduced medication errors by up to 89.1%. Conclusion Interventions involving academic detailing and education, especially when reinforced by feedback, show positive effects on appropriate opioid use among hospital inpatients. Future studies investigating the impact of administrative interventions on opioid use and related outcomes are warranted.

Impact of Check of Medication Appropriateness (CMA) in optimizing analgesic prescribing: An interrupted time series analysis

“…Delivering an academic detailing program to small groups of clinicians by pharmacists could increase the likelihood of prescribers following the pharmacists’ recommendations in the EHR (Bos et al., 2017; Soumerai & Avorn, 1990). Liu et al already concluded that interventions involving academic detailing show positive effects on appropriate opioid prescribing and clinical outcomes related to opioid use among inpatients (Liu et al., 2020).…”

“…Similarly, the main cause of preventable drug‐related admissions for opioids were the occurrence of ADEs (including constipation, nausea, sedation and respiratory depression) and overtreatment (Howard et al., 2007). Recent evidence has suggested that a significant proportion of opioids prescribed during hospital admission are continued post‐discharge, which may contribute to an increased risk of dependence and additional harm (Liu et al., 2020).…”

The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study

“…Increasing the size of the study may also provide a more in-depth look at the results found, such as the impact of study participants and pharmacists demographics on outcome measures (e.g., psychological factors, pharmacy experience, level of knowledge, etc.) [ 25 , 26 ].…”

Academic detailing interventions for opioid-related outcomes: a scoping review

“…Several reviews have assessed interventions used to improve appropriate opioid prescribing. 14 , 15 In 2019, Asamoah-Boaheng et al conducted a systematic review and meta-analysis related to strategies on opioid prescribing for non-cancer pain, including the influence of education, audit, and feedback, interprofessional support, shared decision-making and reported that it was challenging to make conclusions about the effectiveness of such approaches because studies varied in study design and generally were of low methodologic quality. 14 A 2020 systematic review by Liu et al examined the effectiveness of AD and other interventions on opioid prescribing for non-cancer pain in an inpatient setting and reported that whilst the quality of evidence was low, AD and education followed by feedback increased appropriate opioid prescribing in agreement with guidelines.…”