Impact of a physician-targeted letter on opioid prescribing

Ahomäki, Iiro; Pitkänen, Visa; Soppi, Aarni; Saastamoinen, Leena

doi:10.1016/j.jhealeco.2020.102344

Cited by 7 publications

(5 citation statements)

References 40 publications

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“…The absence of substitution to medications recommended in the information letter (venlafaxine, duloxetine, and paracetamol) and to gabapentin is consistent with previous studies that have found no substitution from codeine prescribing to other opioids [ 10 ], or only a small substitution from quetiapine prescribing to other antipsychotics [ 13 ] after similar information interventions. We found no statistically significant reduction in healthcare utilization.…”

Section: Discussionsupporting

confidence: 88%

“…Sacarny et al [ 12 ] evaluated the effect of a peer comparison intervention on over-prescribing of a more wide-ranging class of controlled substances (including, e.g., opioids, amphetamines, and methylphenidate). Our results for prescription outcomes are of the same quantitative magnitude as those of Ahomäki et al [ 10 ], Doctor et al [ 11 ], and Sacarny et al [ 13 ]. However, the null effects of a rather similar large-scale information intervention found by Sacarny et al [ 12 ] stand in contrast to our results.…”

Section: Discussionsupporting

confidence: 87%

“…Recent research examining the effects of large-scale information interventions on opioid [ 10 , 11 ] and antipsychotic prescribing [ 13 ] has found significant decreases in prescribing. Ahomäki et al [ 10 ], Doctor et al [ 11 ], and Sacarny et al [ 13 ] studied the effects of an information intervention, a personal letter informing physicians that their patient had died from an overdose of a controlled substance, and a peer comparison letter accompanied by a notification that physicians’ prescribing was under review, respectively. Sacarny et al [ 12 ] evaluated the effect of a peer comparison intervention on over-prescribing of a more wide-ranging class of controlled substances (including, e.g., opioids, amphetamines, and methylphenidate).…”

Section: Discussionmentioning

confidence: 99%

“…Our study contributes to the literature examining the effects of large-scale information interventions on physicians’ prescribing behavior [ 10 – 13 ]. More generally, evidence on the effectiveness of educational or regulatory interventions on the prescribing behavior is, according to a recent review, relatively sparse [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Information Intervention on Prescribing Practice for Neuropathic Pain in Older Patients: A Nationwide Register-Based Study

et al. 2023

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Introduction Management of prescription medicines is challenging for older patients due to frail health and the prevalence of multiple chronic conditions. A salient policy challenge of prescribing practices is that all physicians are not well informed about the national clinical guidelines. A feasible policy intervention to mitigate the harms caused by Potentially Inappropriate Medications is to influence the frequency of prescribing and other prescribing attributes of the drugs by providing accurate and up-to-date information about the national clinical guidelines. Objectives The objective of this study was to examine the effect of a nationwide information intervention on physicians’ prescribing practices and patients’ healthcare utilization. Methods We used a quasi-experimental research design based on difference-in-differences variation and nationwide register data on prescribers and purchasers of pregabalin, nortriptyline, and amitriptyline combinations in Finland between January 2018 and May 2019. The study included 68,914 patients and 11,432 physicians. Results We found that the information letter sent to all prescribers of pregabalin, nortriptyline, or amitriptyline combinations to patients aged 75 years or older decreased the probability of prescribing of these medications. The estimated effect of − 3.3 percentage points (95% confidence interval [− 0.041, − 0.024]) corresponds to a 29% reduction compared to the baseline mean of the outcome. The filled quantity, measured in Defined Daily Doses, of pregabalin, nortriptyline, and amitriptyline combinations per month was reduced by 11.7% [− 14.5% to − 8.9%] among patients aged 75 years or older. No effect on patients’ healthcare utilization was observed. Conclusions Findings of the study suggest that personal information intervention was an effective policy tool for nudging physicians to reduce prescribing of potentially inappropriate medicines, whereas the reduction in prescribing was not accompanied by improvements or adverse effects in patients’ health. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00993-4.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Information Intervention on Prescribing Practice for Neuropathic Pain in Older Patients: A Nationwide Register-Based Study

et al. 2023

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“…The prescription of the weakest available opioid, codeine, has also been subject to control measures: the authorities have identified heavy prescribers of codeine from the national prescription database, and approached them with targeted education letters. Ahomäki et al have recently modelled the effect of such a targeted letter sent by national authorities to high prescribers of codeine combinations 22 . They estimated that the average number of codeine combination tablets dispensed to new patients decreased by 12.5 percent as a result of the targeted letter.…”

Section: Discussionmentioning

confidence: 99%

Opioid trends in Finland: a register-based nationwide follow-up study

Keto

Heiskanen

Hamunen

et al. 2022

Sci Rep

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The opioid epidemic in the U.S has gotten payers, prescribers, and policymakers alike interested in trends in opioid use. Despite no recognized opioid crisis in Europe, several countries have reported an increase in opioid-related deaths, which has further prompted discussion on the need of monitoring of opioid prescriptions. This study was conducted to offer information on opioid use during the escalation of the U.S. opioid epidemic in Finland, a Nordic country with universal tax-based health care. This is a nationwide retrospective register-based cohort study on all individuals in Finland who were dispensed opioids in 2009–2017 (n of unique patients = 1,761,584). By using the unique personal identification code assigned to every Finnish resident, we linked data from nationwide registers on dispensed drugs, medical history, and socio-demographic parameters. We report a wide set of patient demographics, dispensing trends for all opioid Anatomical Therapeutic Chemical (ATC) classes, and reasons for opioid initiation based on diagnostic coding for the most recent health care visit. For a cohort of incident opioid users with a four-year wash-out period (n = 1 370 057), we also present opioid use patterns in a three-year follow-up: the likelihood of becoming a persistent user or escalating from weak to strong opioids. A steady 7% of the Finnish population were dispensed opioids annually in 2009-2017. The mean annual quantity of dispensed opioids per opioid patient increased between 2009 and 2017 by 33%, reaching 2 583 oral morphine equivalent mg (OMEQ)/patient/year in 2017. The median quantity of dispensed opioids was lower: 315 OMEQ/year/patient. Depending on the opioid ATC class, there were either increasing or decreasing numbers of patients who had been dispensed said opioid class, and also in the mean quantity. The most common reason for opioid initiation was post-surgical pain (20%), followed by musculoskeletal pain (15%), injury (8.3%), and non-postsurgical dental pain (6.2%). 94% of new opioid initiators started with a weak opioid, i.e. codeine or tramadol. 85% of the patients who had been dispensed a weak opioid were not dispensed an opioid subsequently 3–6 months after the first one, and 95% of them had not escalated to a strong opioid in a 3-year follow-up. The number of patients dispensed opioids in Finland did not change during the escalation of the opioid epidemic in the U.S., but there were changes in the quantity of opioids dispensed per patient. Opioid therapy was typically initiated with weak opioid, the initial dispensed prescription was relatively small, and escalation to strong opioids was rare. A considerable share of patients had been prescribed opioids for chronic non-cancer pain - a type of pain where the risk-benefit ratio of opioids is controversial.

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