Feasibility Study of a Quasi‐experimental Regional Opioid Safety Prescribing Program in Veterans Health Administration Emergency Departments

Dieujuste, Nathalie; Johnson‐Koenke, Rachel; Christopher, Melissa L.D.; Gunzburger, Elise; Emmendorfer, Thomas; Kessler, Chad; Haukoos, Jason S.; Smith, J. H. B.; Sasson, Comilla

doi:10.1111/acem.13980

Cited by 10 publications

(37 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of these, 180 were kept for full-text review, and 63 unique studies were included in the review ( Figure 1 ). 12 , 27 , 28 , 29 , 30 , 31 , 32 , 35 , 36 , 37 , 39 , 40 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , …”

Section: Resultsmentioning

confidence: 99%

Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department

et al. 2022

View full text Add to dashboard Cite

Key Points Question Are interventions to reduce pain-related opioid prescribing for patients who are discharged from the emergency department associated with variation in opioid prescription rate and/or prescribed opioid quantity? Findings In this meta-analysis of 63 unique studies, 34 of 51 studies assessing prescribing rates (67%) reported a significant reduction after intervention implementation, and 17 of the 39 studies assessing prescribed opioid quantity (44%) reported a significant intervention-related reduction. There were no data on patient-centered outcomes such as pain relief. Meaning This analysis found that specific interventions may be associated with reducing the opioid prescription rate; however, novel interventions are needed to reduce the quantity of opioids per prescription by emergency department physicians while evaluating their associations with patient-centered outcomes.

show abstract

Section: Resultsmentioning

confidence: 99%

Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Seven interventions used different approaches to examine opioid prescribing or prescribing activities after the AD interventions. 6 , 24 , 26 , 27 , 30 , 31 , 35 In providers that self-reported an intention to change versus none-to-moderate intention to change, Saffore et al compared mean total opioid and high-dose opioid prescriptions per clinician per month before and after the AD intervention. 6 The authors found significantly fewer mean total opioid (−1.48, 95% CI −2.48 to −0.47) and high-dose opioid (−0.50, 95% CI −0.69 to −0.31) prescriptions per clinician per month in the intention to change group compared with the no-to-moderate intention to change group.…”

Section: Resultsmentioning

confidence: 99%

“…Dieujuste et al reported that their multifaceted intervention of AD, audit, feedback and addition of electronic medical record prescribing resources resulted in the ED opioid prescribing rate decreasing by 47% over 21 months. 31 …”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Kulbokas¹,

Hanson²,

Smart³

et al. 2021

DIC

View full text Add to dashboard Cite

Background Academic detailing (AD) is a tailored, interactive educational outreach intervention that may improve patient outcomes. Insight into the design of AD interventions and the extent to which they are effective can help inform future AD-based programmes. The objective of this scoping review was to characterize opioid-focused AD interventions and describe their findings. Methods A scoping review focused on AD interventions for opioids was conducted in PubMed, EMBASE and CINAHL databases through July 1, 2021. Studies were eligible for inclusion if written in English, included interactive opioid-focused educational interventions, and were conducted either in person, virtually or via telephone. Four independent reviewers reviewed titles and abstracts. Data extraction from full-text publications was completed using a standardized form. Results Of 6086 articles initially identified, 22 articles met the inclusion criteria and 20 unique interventions were identified. The AD intervention was either delivered one-on-one ( n =16) or in a small, interactive group setting ( n =4). AD interventions varied in design. Effectiveness was evaluated in terms of opioid and naloxone prescribing rates, provider knowledge gaps, provider adherence to guidelines, and intervention feasibility. Sixteen (80%) interventions resulted in statistically significant improvement in one or more outcomes. Conclusion Generally, opioid-related AD was effective and programmes were primarily conducted one-on-one between pharmacists and primary care providers for 16–30 minutes. A variety of metrics and outcomes were used to assess the success/effectiveness of AD interventions, which is an important consideration in future studies as no single metric captures the effectiveness of an educational outreach-based intervention for pain management.

show abstract

“…Results from the pilot suggested that our program was associated with accelerating the rate at which ED prescribing rates decreased. 11 In addition, the pilot found that ED-based QI initiatives in VHA facilities are a feasible practice. As we work to develop and implement the next 2 phases of the QI program, a major consideration is to identify facilitators and address any existing barriers to the implementation of naloxone distribution (aim 2) and MATinitiation (aim 3) programs for treatmentnaïve patients from VHA EDs.…”

mentioning

confidence: 99%

Provider Perceptions of Opioid Safety Measures in VHA Emergency Departments and Urgent Care Centers

Dieujuste¹

2021

Federal Practitioner

Self Cite

View full text Add to dashboard Cite

Background: A priority for Veterans Health Administration (VHA) leadership is increasing access to lifesaving treatment, particularly naloxone distribution and medication-assisted treatment (MAT) for opioid use disorder (OUD) for veterans. To date, these practices are not widely done in the VHA emergency departments (ED) and urgent care centers (UCC). Methods: The goal of this research was to understand advanced care provider perceptions of barriers and facilitators to naloxone distribution or MAT initiation in VHA ED/UCCs. We developed and disseminated a survey to VHA ED and UCC advanced care providers, including medical doctors (MD/DO), physician assistants (PAs), and nurse practitioners (NPs). Descriptive statistical analysis was conducted. Results: There was 16.7% response rate (372 out of 2228 providers) from 103 of 132 sites across all VA regions. The top barrier for ED/UCCs providers to both naloxone and MAT initiation was the feeling that it was beyond their scope of practice (35.2% and 53.2%, respectively). Other reported barriers to MAT initiation included unclear follow-up plan and system for referral of care (50.1%) and feeling uncomfortable using MAT medications (28.8%). Top facilitators for prescribing naloxone included pharmacist who could help prescribe/educate the patient on the medication (44.6%) and patient knowledge of medication options to help overdose (31.7%). The top facilitator for MAT initiation from the ED/UCC was additional VA-based same day treatment options (34.9%). Conclusions: Present findings offer a look into possible challenges to address or opportunities to leverage when considering or developing an ED/UCC-based naloxone distribution or MAT-initiation implementation program in VHA facilities.

show abstract

Feasibility Study of a Quasi‐experimental Regional Opioid Safety Prescribing Program in Veterans Health Administration Emergency Departments

Cited by 10 publications

References 11 publications

Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department

Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department

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

Provider Perceptions of Opioid Safety Measures in VHA Emergency Departments and Urgent Care Centers

Contact Info

Product

Resources

About