Individualized prescribing portraits to reduce inappropriate initiation of opioid analgesics to opioid naïve patients in primary care: Protocol for a randomized controlled trial

Klimas, Jan; Hamilton, Michee-Ana; Carney, Greg; Cooper, Ian R; Croteau, Nicole; Dong, Huiru; Dormuth, Colin R.; Maclure, Malcolm; Socías, M. Eugenia; Ti, Lianping; Wood, Evan; McCracken, Rita

doi:10.1016/j.cct.2021.106462

Cited by 5 publications

(4 citation statements)

References 28 publications

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“… 17 Systematic reviews 30 , 31 of prescription monitoring programs in the USA and Canada show that such programs reduce per capita analgesic prescription, with overall fewer MME prescribed in USA states with monitoring programs than without, particularly for high potency opioids. Feedback to individual prescribers comparing their rates of prescribing opioids to opioid-naïve patients was provided to general practitioners in BC in 2020–2021, 32 and their prescribing portraits are now online confidentially. 33 Prescribing feedback has been shown to have positive impacts in BC.…”

Section: Discussionmentioning

confidence: 99%

Tendances de la délivrance d’opioïdes après des interventions courantes de chirurgie abdominale et orthopédique en Colombie-Britannique : une analyse rétrospective de cohorte

Nann

Nabavi

Ziafat

et al. 2022

Can J Anesth/J Can Anesth

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Purpose Postdischarge opioid prescriptions are reportedly much higher in Canada than in other countries. To assess potentially contributing factors, we examined trends after abdominal and orthopedic surgeries in British Columbia (BC). Methods Using the BC Ministry of Health’s databases on physician billings, hospital discharge abstracts, and medication dispensations in community pharmacies for the period 2003–2016, we assembled a cohort of 263,056 patients who received laparoscopic appendectomy (LA, 11%), laparoscopic cholecystectomy (LC, 30%), open inguinal or femoral hernia repair (IHR, 20%), total hip arthroplasty (THA, 18%), or total knee arthroplasty (TKA, 22%). Adjusting for covariates using generalized linear modeling, we measured trends in percentages of patients dispensed opioids postdischarge (opioid rate) within 30 days after surgery, by surgery type, opioid type, prior use, surgeon, and trends in morphine milligram equivalents of first dispensations (MME) with 95% confidence intervals (CI). Results Opioid dispensation rates rose steadily. Mean annual increases were 1.7% in LA; 1.3% in LC; 0.8% in IHR; 0.9% in THA; and 0.8% in TKA. By 2016, rates were 69% in LA; 76% in LC; 81% in IHR; 88% in THA; and 94% in TKA. Codeine dispensations fell 2.4% (abdominal) and 3.1% (orthopedic) per year while tramadol dispensations increased 3.6% (abdominal) and 1.7% (orthopedic). Hydromorphone dispensations increased 2.9% per year (orthopedic); oxycodone was level at 22% between 2007 and 2014, but then fell. The mean MME rose 8 mg⋅yr -1 (95% CI, 7 to 9) (abdominal) and 61 mg⋅yr -1 (95% CI, 58 to 64) (orthopedic). Variation in rates was greater among abdominal than orthopedic surgeons. Conclusion Rising opioid dispensation rates, together with shifts to prescribing higher MME opioids, doubled MME per patient in first dispensations postdischarge after abdominal or orthopedic surgery from 2003 to 2016 in BC. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-022-02272-7.

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Section: Discussionmentioning

confidence: 99%

Tendances de la délivrance d’opioïdes après des interventions courantes de chirurgie abdominale et orthopédique en Colombie-Britannique : une analyse rétrospective de cohorte

Nann

Nabavi

Ziafat

et al. 2022

Can J Anesth/J Can Anesth

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“…47,48 This data will inform a randomized clinical trial to examine the effectiveness and acceptability of individualized prescribing portraits and educational supports for reducing initiation of opioid analgesics among opioid naïve patients attending primary care. 49,50 The trial draws upon a growing body of research which has established the importance of opioid-sparing approaches to evidence-based pain management 51 and the significant beneficial effects of audit and feedback (individualized prescribing portraits) on new prescribing for both acute and chronic conditions. 23 It is hoped that data from the future clinical trial will help us better understand and model the physician and patient (eg, patient age, socio-economic status, comorbidity, preceding surgical procedures) predictors of higher rates of initiation, as well as differing patterns for specific opioid analgesics.…”

Section: Discussionmentioning

confidence: 99%

“…Such investigations should focus on time pressure and lack of continuity as potential contributors to the physicians’ incongruent prescribing patterns, especially for opioids and other types of psychotropic drugs 47,48 . This data will inform a randomized clinical trial to examine the effectiveness and acceptability of individualized prescribing portraits and educational supports for reducing initiation of opioid analgesics among opioid naïve patients attending primary care 49,50 . The trial draws upon a growing body of research which has established the importance of opioid-sparing approaches to evidence-based pain management 51 and the significant beneficial effects of audit and feedback (individualized prescribing portraits) on new prescribing for both acute and chronic conditions 23 .…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Incidence of Opioid Analgesic Initiations to Opioid Naïve Patients in a Canadian Primary Care Setting

Klimas

Hamilton

Carney

et al. 2022

Canadian Journal of Addiction

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Objective:To examine characteristics and incidence of opioid analgesic initiations to opioid naïve patients in a Canadian primary care setting.Methods:This is a population-based cross-sectional study, outlining an analysis of health administrative data recorded in a centralized medication monitoring database (PharmaNet) covering 96% of population in British Columbia, Canada. From the PharmaNet database, 5657 doctors (87% of all practicing family physicians) were selected on the bases of (1) having been currently treating patients (defined as having written at least 25 prescriptions, for any drug, in preceding 12 months); and (2) having prescribed at least 1 opioid during study period. The primary outcome measure is incidence of new starts for opioid analgesics in opioid naïve people, stratified by several important prescriber and regional characteristics (eg, graduation year, geographical location).Results:Between December 1, 2018 and November 30, 2019, there were 139,145 opioid initiations to opioid naïve patients. The mean monthly initiation rate was 2.05 prescriptions per physician. Most initiations were in Lower Mainland regions of British Columbia, also where the population is most concentrated (46,456, 33% in the Fraser region), by prescribers who graduated between 1986 and 1995 (39,601, 28%), and had less than 10 patient visits per day (72,506, 52%).Conclusions:From data presented in this study, it appears that the rate of opioid analgesic initiations in primary care remains unchanged. Individualized prescribing interventions targeted at physicians are urgently needed considering the current opioid epidemic and known links with opioid analgesics that raise concerns about the potential to cause harm.

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“…Shifting to an environment involving the regular use of random assignment in studies of social policy need not be difficult. In BC, new initiatives under the Academic Detailing program (Jin et al, 2012) and the Portraits program (Klimas et al, 2021) are routinely rolled out with random assignment-and the BC Cancer Agency has enrolled more than 34,000 patients in randomized trials. All that is needed is to apply this existing expertise in other areas.…”

Section: A Credible Path Forwardmentioning

confidence: 99%

A Scientific Approach to Addressing Social Issues Using Administrative Data

Green,

Simard-Duplain,

Sweetman

et al. 2023

Canadian Public Policy

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Nous utilisons des données administratives en chaine sur l’éducation, la santé, les services sociaux et la criminalité en Colombie-Britannique, au Canada, pour documenter la relation entre le niveau de scolarité mesuré au secondaire et les indicateurs de résultats défavorables plus tard dans la vie. Les résultats défavorables s’observent principalement chez les décrocheurs et décrocheuses du secondaire. Nous documentons ensuite la capacité des caractéristiques observées en 4e année du primaire à prédire l’obtention du diplôme d’études secondaires, au moyen d’un modèle simple produisant une limite inférieure. Le modèle identifie directement plus d’un cinquième des futurs décrocheurs et décrocheuses avec une précision raisonnable. Les mesures non cognitives (en particulier les caractéristiques sociales et émotionnelles) sont de meilleurs prédicteurs du niveau de scolarité que les mesures cognitives. Nous examinons les implications de ces résultats dans le contexte du développement scientifique des interventions qui visent à prévenir les résultats défavorables plus tard dans la vie.

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Individualized prescribing portraits to reduce inappropriate initiation of opioid analgesics to opioid naïve patients in primary care: Protocol for a randomized controlled trial

Cited by 5 publications

References 28 publications

Tendances de la délivrance d’opioïdes après des interventions courantes de chirurgie abdominale et orthopédique en Colombie-Britannique : une analyse rétrospective de cohorte

Tendances de la délivrance d’opioïdes après des interventions courantes de chirurgie abdominale et orthopédique en Colombie-Britannique : une analyse rétrospective de cohorte

Characteristics and Incidence of Opioid Analgesic Initiations to Opioid Naïve Patients in a Canadian Primary Care Setting

A Scientific Approach to Addressing Social Issues Using Administrative Data

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