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Variation in opioid prescribing patterns between ED providers.
Intern Emerg Med. 2016 Dec; 11(8):1121-1124.IE

Abstract

Abuse of opioid prescription drugs has become an epidemic across the developed world. Despite the fact that emergency physicians overall account for a small proportion of total opioids prescribed, the number of prescriptions has risen dramatically in the past decade and, to some degree, contributes to the available supply of opioids in the community, some of which are diverted for non-medical use. Since successfully reducing opioid prescribing on the individual level first requires knowledge of current prescribing patterns, we sought to determine to what extent variation exists in opioid prescribing patterns at our institution. This was a single-institution observational study at a community hospital with an annual ED volume of 47,000 visits. We determined the number of prescriptions written by each provider, both total number and accounting for the number of patients seen. Our primary outcome measure was the level of variation at the physician level for number of prescriptions written per patient. We also identified the mean number of pills written per prescription. We analyzed data from November 13, 2014 through July 31, 2015 for 21 full-time providers. There were a total of 2211 prescriptions for opioids written over this time period for a total of 17,382 patients seen. On a per-patient basis, the rate of opioid prescriptions written per patient during this period was 127 per 1000 visits (95 % CI 122-132). There was a variation on the individual provider level, with rates ranging from 33 per to 332 per 1000 visits. There was also substantial variation by provider in the number of pills written per prescription with coefficient of variation (standard deviation divided by mean) averaged over different opioids ranging from 16 to 40 %. There was significant variation in opioid prescribing patterns at the individual physician level, even when accounting for the number of patients seen.

Authors+Show Affiliations

Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. psmulowi@bidmc.harvard.edu.Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, MA, USA.Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.Department of Emergency Medicine, Beth Israel Deaconess Hospital-Plymouth, Plymouth, MA, USA.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27424280

Citation

Smulowitz, Peter B., et al. "Variation in Opioid Prescribing Patterns Between ED Providers." Internal and Emergency Medicine, vol. 11, no. 8, 2016, pp. 1121-1124.
Smulowitz PB, Cary C, Boyle KL, et al. Variation in opioid prescribing patterns between ED providers. Intern Emerg Med. 2016;11(8):1121-1124.
Smulowitz, P. B., Cary, C., Boyle, K. L., Novack, V., & Jagminas, L. (2016). Variation in opioid prescribing patterns between ED providers. Internal and Emergency Medicine, 11(8), 1121-1124.
Smulowitz PB, et al. Variation in Opioid Prescribing Patterns Between ED Providers. Intern Emerg Med. 2016;11(8):1121-1124. PubMed PMID: 27424280.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variation in opioid prescribing patterns between ED providers. AU - Smulowitz,Peter B, AU - Cary,Chris, AU - Boyle,Katherine L, AU - Novack,Victor, AU - Jagminas,Liudvikas, Y1 - 2016/07/16/ PY - 2016/04/01/received PY - 2016/07/08/accepted PY - 2016/7/18/pubmed PY - 2017/9/19/medline PY - 2016/7/18/entrez KW - Emergency department KW - Opioids KW - Variation SP - 1121 EP - 1124 JF - Internal and emergency medicine JO - Intern Emerg Med VL - 11 IS - 8 N2 - Abuse of opioid prescription drugs has become an epidemic across the developed world. Despite the fact that emergency physicians overall account for a small proportion of total opioids prescribed, the number of prescriptions has risen dramatically in the past decade and, to some degree, contributes to the available supply of opioids in the community, some of which are diverted for non-medical use. Since successfully reducing opioid prescribing on the individual level first requires knowledge of current prescribing patterns, we sought to determine to what extent variation exists in opioid prescribing patterns at our institution. This was a single-institution observational study at a community hospital with an annual ED volume of 47,000 visits. We determined the number of prescriptions written by each provider, both total number and accounting for the number of patients seen. Our primary outcome measure was the level of variation at the physician level for number of prescriptions written per patient. We also identified the mean number of pills written per prescription. We analyzed data from November 13, 2014 through July 31, 2015 for 21 full-time providers. There were a total of 2211 prescriptions for opioids written over this time period for a total of 17,382 patients seen. On a per-patient basis, the rate of opioid prescriptions written per patient during this period was 127 per 1000 visits (95 % CI 122-132). There was a variation on the individual provider level, with rates ranging from 33 per to 332 per 1000 visits. There was also substantial variation by provider in the number of pills written per prescription with coefficient of variation (standard deviation divided by mean) averaged over different opioids ranging from 16 to 40 %. There was significant variation in opioid prescribing patterns at the individual physician level, even when accounting for the number of patients seen. SN - 1970-9366 UR - https://www.unboundmedicine.com/medline/citation/27424280/Variation_in_opioid_prescribing_patterns_between_ED_providers_ L2 - https://dx.doi.org/10.1007/s11739-016-1505-8 DB - PRIME DP - Unbound Medicine ER -