Trends in opioid prescribing before and after implementation of an emergency department opioid prescribing policy

Beaudoin, Francesca L.; Janicki, Adam; Zhai, Wanting; Choo, Esther K.

doi:10.1016/j.ajem.2017.07.068

Cited by 13 publications

(38 citation statements)

References 10 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%

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%

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

et al. 2022

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“…One multi-center study found that APPs were less likely to prescribe an opioid for musculoskeletal pain 25 , whereas a larger but single-center study reported the opposite finding (for a broader range of diagnoses). 26 Because APPs are commonly utilized to improve physician productivity and access to care 27 , they may be the recipients of postoperative opioid refill requests and be hesitant to prescribe smaller amounts. Alternatively, APPs may have different perceptions and attitudes around pain management that lead to higher prescribing.…”

Section: Discussionmentioning

confidence: 99%

Provider Characteristics Associated With Outpatient Opioid Prescribing After Surgery

et al. 2020

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Objective: To characterize differences in postoperative opioid prescribing across surgical, nonsurgical, and advanced practice providers. Background: There is a critical need to identify best practices around perioperative opioid prescribing. To date, differences in postoperative prescribing among providers are poorly understood. Methods: This is a retrospective multi-center analysis of commercial insurance claims from a statewide quality collaborative. We identified 15,657 opioid-naïve patients who underwent a range of surgical procedures between January 2012 and October 2015 and filled an opioid prescription within 30 days postoperatively. Our primary outcome was total amount of opioid filled per prescription within 30 days postoperatively (in oral morphine equivalents [OME]). Hierarchical linear regression was used to determine the association between provider characteristics (specialty, advanced practice providers [nurse practitioners and physician assistants] vs. physician, and gender) and outcome while adjusting for patient factors. Results: Average postoperative opioid prescription amount was 326 ± 285 OME (equivalent: 65 tablets of 5 mg hydrocodone). Advanced practice providers accounted for 19% of all prescriptions, and amount per prescription was 18% larger in this group compared to physicians (315 vs. 268, P<0.001). Primary care providers accounted for 13% of all prescriptions and prescribed on average 279 OME per prescription. The amount of opioid prescribed varied by surgical specialty and ranged from 178 OME (urology) to 454 OME (neurosurgery).

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“…[5][6][7] One suggestion shown to help standardize prescription practices is the creation of opioid prescription guidelines. [11][12][13] To date, there are no validated guidelines on opioid prescriptions for acute musculoskeletal fractures in the ED.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have suggested that guidelines may be an effective tool to help standardize prescription practices. [11][12][13] However, there are currently no validated guidelines for acute musculoskeletal pain secondary to fractures, and variation continues to exist.…”

Section: Introductionmentioning

confidence: 99%

Opioid prescription practices for patients discharged from the emergency department with acute musculoskeletal fractures

Mok

Newton

Thurgur

et al. 2020

CJEM

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Background Opioid related mortality rate has increased 200% over the past decade. Studies show variable emergency department (ED) opioid prescription practices and a correlation with increased long-term use. ED physicians may be contributing to this problem. Our objective was to analyze ED opioid prescription practices for patients with acute fractures. Methods We conducted a review of ED patients seen at two campuses of a tertiary care hospital. We evaluated a consecutive sample of patients with acute fractures (January 2016–April 2016) seen by ED physicians. Patients admitted or discharged by consultant services were excluded. The primary outcome was the proportion of patients discharged with an opioid prescription. Data were collected using screening lists, electronic records, and interobserver agreement. We calculated simple descriptive statistics and a multivariable analysis. Results We enrolled 816 patients, including 441 females (54.0%). Most common fracture was wrist/hand (35.2%). 260 patients (31.8%) were discharged with an opioid; hydromorphone (N = 115, range 1–120 mg) was most common. 35 patients (4.3%) had pain related ED visits <1 month after discharge. Fractures of the lumbar spine (OR 10.78 [95% CI: 3.15–36.90]) and rib(s)/sternum/thoracic spine (OR 5.46 [95% CI: 2.88–10.35)] had a significantly higher likelihood of opioid prescriptions. Conclusions The majority of patients presenting to the ED with acute fractures were not discharged with an opioid. Hydromorphone was the most common opioid prescribed, with large variations in total dosage. Overall, there were few return to ED visits. We recommend standardization of ED opioid prescribing, with attention to limiting total dosage.

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Trends in opioid prescribing before and after implementation of an emergency department opioid prescribing policy

Cited by 13 publications

References 10 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

Provider Characteristics Associated With Outpatient Opioid Prescribing After Surgery

Opioid prescription practices for patients discharged from the emergency department with acute musculoskeletal fractures

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