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Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy.
J Emerg Med. 2017 Apr; 52(4):538-546.JE

Abstract

BACKGROUND

Prescription opioid-associated abuse and overdose is a significant cause of morbidity and mortality in the United States. Opioid prescriptions generated from emergency departments (EDs) nationwide have increased dramatically over the past 20 years, and opioid-related overdose deaths have become an epidemic, according to the Centers for Disease Control and Prevention.

OBJECTIVE

Our aim was to determine the effectiveness of implementing a prescription policy for opioids on overall opioid prescribing patterns in a hospital ED.

METHODS

The ED provider group of an academic, non-university-affiliated urban hospital with 23,000 annual patient visits agreed to opioid prescribing guidelines for chronic pain with the goal of limiting prescriptions that may be used for abuse or diversion. These guidelines were instituted in the ED through collaborative staff meetings and educational and training sessions. We used the electronic medical record to analyze the number and type of opioid discharge prescriptions during the study period from 2006-2014, before and after the prescribing guidelines were instituted in the ED.

RESULTS

The number of patients discharged with a prescription for opioids decreased 39.6% (25.7% to 15.6%; absolute decrease 10.2%; 95% confidence interval [CI] 9.6-10.7; p < 0.001) after the intervention. The improvements were sustained 2.5 years after the intervention. Decreases were seen in all major opioids (hydrocodone, oxycodone, hydromorphone, and codeine). The number of pills per prescription also decreased 14.8%, from 19.5% to 16.6% (absolute decrease 2.9; 95% CI 2.6-3.1; p < 0.001).

CONCLUSIONS

Implementation of an ED prescription opioid policy was associated with a significant reduction in total opioid prescriptions and in the number of pills per prescription.

Authors+Show Affiliations

Virginia Mason Medical Center, Seattle, Washington.Virginia Mason Medical Center, Seattle, Washington.Virginia Mason Medical Center, Seattle, Washington.Virginia Mason Medical Center, Seattle, Washington.Virginia Mason Medical Center, Seattle, Washington.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28111065

Citation

Osborn, Scott R., et al. "Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy." The Journal of Emergency Medicine, vol. 52, no. 4, 2017, pp. 538-546.
Osborn SR, Yu J, Williams B, et al. Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy. J Emerg Med. 2017;52(4):538-546.
Osborn, S. R., Yu, J., Williams, B., Vasilyadis, M., & Blackmore, C. C. (2017). Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy. The Journal of Emergency Medicine, 52(4), 538-546. https://doi.org/10.1016/j.jemermed.2016.07.120
Osborn SR, et al. Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy. J Emerg Med. 2017;52(4):538-546. PubMed PMID: 28111065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy. AU - Osborn,Scott R, AU - Yu,Julianna, AU - Williams,Barbara, AU - Vasilyadis,Maria, AU - Blackmore,C Craig, Y1 - 2017/01/19/ PY - 2015/06/12/received PY - 2016/01/15/revised PY - 2016/07/19/accepted PY - 2017/1/24/pubmed PY - 2017/11/29/medline PY - 2017/1/24/entrez KW - chronic pain KW - narcotic KW - opioid KW - overdose KW - prescription policy SP - 538 EP - 546 JF - The Journal of emergency medicine JO - J Emerg Med VL - 52 IS - 4 N2 - BACKGROUND: Prescription opioid-associated abuse and overdose is a significant cause of morbidity and mortality in the United States. Opioid prescriptions generated from emergency departments (EDs) nationwide have increased dramatically over the past 20 years, and opioid-related overdose deaths have become an epidemic, according to the Centers for Disease Control and Prevention. OBJECTIVE: Our aim was to determine the effectiveness of implementing a prescription policy for opioids on overall opioid prescribing patterns in a hospital ED. METHODS: The ED provider group of an academic, non-university-affiliated urban hospital with 23,000 annual patient visits agreed to opioid prescribing guidelines for chronic pain with the goal of limiting prescriptions that may be used for abuse or diversion. These guidelines were instituted in the ED through collaborative staff meetings and educational and training sessions. We used the electronic medical record to analyze the number and type of opioid discharge prescriptions during the study period from 2006-2014, before and after the prescribing guidelines were instituted in the ED. RESULTS: The number of patients discharged with a prescription for opioids decreased 39.6% (25.7% to 15.6%; absolute decrease 10.2%; 95% confidence interval [CI] 9.6-10.7; p < 0.001) after the intervention. The improvements were sustained 2.5 years after the intervention. Decreases were seen in all major opioids (hydrocodone, oxycodone, hydromorphone, and codeine). The number of pills per prescription also decreased 14.8%, from 19.5% to 16.6% (absolute decrease 2.9; 95% CI 2.6-3.1; p < 0.001). CONCLUSIONS: Implementation of an ED prescription opioid policy was associated with a significant reduction in total opioid prescriptions and in the number of pills per prescription. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/28111065/Changes_in_Provider_Prescribing_Patterns_After_Implementation_of_an_Emergency_Department_Prescription_Opioid_Policy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(16)30988-X DB - PRIME DP - Unbound Medicine ER -