Longitudinal impact of a pre‐populated default quantity on emergency department opioid prescriptions

Carlson, Alexandra; Nelson, M. E.; Patel, Hina

doi:10.1002/emp2.12337

Cited by 7 publications

(25 citation statements)

References 28 publications

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“…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%

“…Studies used mainly preintervention-postintervention (n = 39) 12 , 28 , 30 , 31 , 32 , 35 , 39 , 40 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 92 , 93 , 94 , 99 , 100 , 101 , 102 and ITS (n = 21) 27 , 29 , 36 , 37 , 54 , 55 , 56 , 57 , 71 , 72 , 73 , 74 , 87 , 88 , 89 , 90 , 91 , 95 , 96 , 97 , 98 designs; only 1 was an RCT,…”

Section: Resultsmentioning

confidence: 99%

“… 103 , 104 The EPG intervention was used to help reduce opioid prescriptions in 21 studies 31 , 32 , 35 , 36 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ; PDMP, in 19 studies 27 , 28 , 29 , 30 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ; EMR-QC, in 11 studies 37 , 39 , 40 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 ; CPC, in 10 studies 12 , 86 , 87 , 88 , 89 , 90 , …”

Section: Resultsmentioning

confidence: 99%

“… 103 , 104 Fifty-two studies 12 , 27 , 28 , 29 , 31 , 35 , 36 , 37 , 39 , 40 , 54 , 55 , 57 , 59 , 60 , 61 , 62 , 65 , 66 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 included a mix of pain problems, and 56 included both acute and chronic pain. 12 , 27 , 28 , 29 , 30 , 31 , …”

Section: Resultsmentioning

confidence: 99%

“…Ten of 21 ITS studies 27 , 36 , 54 , 55 , 56 , 57 , 88 , 89 , 90 , 91 demonstrated an overall moderate risk of bias (ROBINS-I); all other ITS and preintervention-postintervention studies 12 , 28 , 29 , 30 , 31 , 32 , 35 , 37 , 39 , 40 , 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 , 87 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , ...…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2022

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Association Between Default Number of Opioid Doses in Electronic Health Record Systems and Opioid Prescribing to Adolescents and Young Adults Undergoing Tonsillectomy

Chua

Thorne

et al. 2022

JAMA Netw Open

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IMPORTANCEIn prior studies, decreasing the default number of doses in opioid prescriptions written in electronic health record systems reduced opioid prescribing. However, these studies did not rigorously assess patient-reported outcomes, and few included pediatric patients.OBJECTIVE To evaluate the association between decreasing the default number of doses in opioid prescriptions written in electronic health record systems and opioid prescribing and patient-reported outcomes among adolescents and young adults undergoing tonsillectomy. DESIGN, SETTING, AND PARTICIPANTSThis nonrandomized clinical trial included adolescents and young adults aged 12 to 50 years undergoing tonsillectomy from October 1, 2019, through July 31, 2021, at a tertiary medical center. The treatment group comprised patients from a pediatric otolaryngology service (mostly aged 12-21 years) and the control group comprised patients from a general otolaryngology service (mostly aged 18-25 years).INTERVENTIONS Data on patient-reported opioid consumption and outcomes were collected via a survey on postoperative day 14. Based on opioid consumption among pediatric otolaryngology patients before the intervention, the default number of opioid doses was decreased from 30 to 12 in a tonsillectomy order set. This change occurred only for pediatric otolaryngology patients. MAIN OUTCOMES AND MEASURESProportion of patients with 12 doses in the discharge opioid prescription, number of doses in this prescription, and refills and pain-related visits within 2 weeks of surgery. In a secondary analysis of patients completing the postoperative survey, patient-reported opioid consumption, pain control, sleep disturbance, anxiety, and depression were assessed. Linear or log-linear difference-in-differences models were fitted, adjusting for patients' demographic characteristics and presence of a mental health or substance use disorder. RESULTSThe study included 237 patients (147 female patients [62.0%]; mean [SD] age, 17.3 [3.6] years). Among 131 pediatric otolaryngology patients, 1 of 70 (1.4%) in the preintervention period and 27 of 61 (44.3%) in the postintervention period had 12 doses in the discharge opioid prescription (differential change, 45.5 percentage points; 95% CI, 32.2-58.8 percentage points). Among pediatric otolaryngology patients, the mean (SD) number of doses prescribed in the preintervention period was 22.3 (7.4) and in the postintervention period was 16.1 (6.5) (differential percentage change, -29.2%; 95% CI, -43.2% to -11.7%). The intervention was not associated with changes in refills or pain-related visits. The secondary analysis included 150 patients. The intervention was not associated with changes in patient-reported outcomes except for a 3.5-point (95% CI, 1.5-5.5 points) differential increase in a sleep disturbance score that ranged from 4 to 20, with higher scores indicating poorer sleep quality. (continued) Key Points Question Is decreasing the default number of doses in opioid prescriptions written in electronic health record systems ass...

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Surgeons’ Perspectives on Changing the Default Number of Doses for Opioid Prescriptions in Electronic Health Record Systems

et al. 2023

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ImportanceAn intervention in 2021 at a tertiary medical center found that the implementation of evidence-based default dosing settings for opioid prescriptions written in electronic health record systems was associated with reduced opioid prescribing to adolescents and young adults aged 12 to 25 years undergoing tonsillectomy. It is unclear whether surgeons were aware of this intervention, whether they thought the intervention was acceptable, or whether they believed similar interventions were feasible to implement in other surgical populations and institutions.ObjectiveTo assess surgeons’ experiences and perspectives regarding an intervention that changed the default number of doses for opioid prescriptions to an evidence-based level.Design, Setting, and ParticipantsThis qualitative study was conducted at a tertiary medical center during October 2021, 1 year after implementation of the intervention, in which the default number of doses for opioid prescriptions written through an electronic health record system to adolescents and young adults undergoing tonsillectomy was lowered to an evidence-based level. Semistructured interviews were conducted with otolaryngology attending and resident physicians who had cared for the adolescents and young adults undergoing tonsillectomy after implementation of the intervention. Factors that play a role in opioid prescribing decisions after surgery and participants’ awareness of and views on the intervention were assessed. The interviews were coded inductively and a thematic analysis was performed. Analyses were conducted from March to December 2022.ExposureChange in the default dosing settings for opioid prescriptions written in an electronic health record system to adolescents and young adults undergoing tonsillectomy.Main Outcomes and MeasuresSurgeons’ experiences and perspectives regarding the intervention.ResultsThe 16 otolaryngologists interviewed included 11 residents (68.8%), 5 attending physicians (31.2%), and 8 women (50.0%). No participant reported noticing the change in the default settings, including those who wrote opioid prescriptions with the new default number of opioid doses. From the interviews, 4 themes regarding surgeons' perceptions and experiences of the intervention emerged: (1) opioid prescribing decisions are influenced by patient, procedure, physician, and health system factors; (2) defaults may substantially influence prescribing behavior; (3) support for the default dosing setting intervention depended on whether it was evidence-based and had unintended consequences; and (4) changing the default dosing settings is potentially feasible in other surgical populations and institutions.Conclusions and RelevanceThese findings suggest that interventions to change the default dosing settings for opioid prescriptions may be feasible to implement in a variety of surgical populations, particularly if the new settings are evidence-based and if unintended consequences are carefully monitored.

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Longitudinal impact of a pre‐populated default quantity on emergency department opioid prescriptions

Cited by 7 publications

References 28 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

Association Between Default Number of Opioid Doses in Electronic Health Record Systems and Opioid Prescribing to Adolescents and Young Adults Undergoing Tonsillectomy

Surgeons’ Perspectives on Changing the Default Number of Doses for Opioid Prescriptions in Electronic Health Record Systems

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