دورية أكاديمية
أعرض في EDS

Effect Of A "No Superuser Opioid Prescription" Policy On ED Visits And Statewide Opioid Prescription.

التفاصيل البيبلوغرافية
العنوان: Effect Of A "No Superuser Opioid Prescription" Policy On ED Visits And Statewide Opioid Prescription.
المؤلفون: Kahler ZP; Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.; University of South Carolina, Greenville School of Medicine, Department of Emergency Medicine, Greenville, South Carolina., Musey PI; Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.; Indiana University Health Methodist Hospital, Indianapolis, Indiana., Schaffer JT; Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.; Indiana University Health Methodist Hospital, Indianapolis, Indiana., Johnson AN; Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.; Indiana University Health Methodist Hospital, Indianapolis, Indiana., Strachan CC; Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.; Indiana University Health Methodist Hospital, Indianapolis, Indiana., Shufflebarger CM; Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.; Indiana University Health Methodist Hospital, Indianapolis, Indiana.
المصدر: The western journal of emergency medicine [West J Emerg Med] 2017 Aug; Vol. 18 (5), pp. 894-902. Date of Electronic Publication: 2017 Jul 25.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Department of Emergency Medicine, University of California, Irvine Country of Publication: United States NLM ID: 101476450 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1936-9018 (Electronic) Linking ISSN: 1936900X NLM ISO Abbreviation: West J Emerg Med Subsets: MEDLINE
أسماء مطبوعة: Publication: <2011>- : Irvine, CA : Department of Emergency Medicine, University of California, Irvine
Original Publication: Orange, CA : California Chapter of the American Academy of Emergency Medicine
مواضيع طبية MeSH: Drug Overdose/*prevention & control , Emergency Service, Hospital/*standards , Inappropriate Prescribing/*prevention & control , Opioid-Related Disorders/*prevention & control , Practice Patterns, Physicians'/*statistics & numerical data , Prescription Drug Misuse/*prevention & control, Adolescent ; Adult ; Aged ; Chronic Pain ; Clinical Protocols ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Pain Management ; Referral and Consultation ; Retrospective Studies ; Young Adult
مستخلص: Introduction: The U.S. opioid epidemic has highlighted the need to identify patients at risk of opioid abuse and overdose. We initiated a novel emergency department- (ED) based interventional protocol to transition our superuser patients from the ED to an outpatient chronic pain program. The objective was to evaluate the protocol's effect on superusers' annual ED visits. Secondary outcomes included a quantitative evaluation of statewide opioid prescriptions for these patients, unique prescribers of controlled substances, and ancillary testing.
Methods: Patients were referred to the program with the following inclusion criteria: ≥ 6 visits per year to the ED; at least one visit identified by the attending physician as primarily driven by opioid-seeking behavior; and a review by a committee comprising ED administration and case management. Patients were referred to a pain management clinic and informed that they would no longer receive opioid prescriptions from visits to the ED for chronic pain complaints. Electronic medical record (EMR) alerts notified ED providers of the patient's referral at subsequent visits. We analyzed one year of data pre- and post-referral.
Results: A total of 243 patients had one year of data post-referral for analysis. Median annual ED visits decreased from 14 to 4 (58% decrease, 95% CI [50 to 66]). We also found statistically significant decreases for these patients' state prescription drug monitoring program (PDMP) opioid prescriptions (21 to 13), total unique controlled-substance prescribers (11 to 7), computed tomography imaging (2 to 0), radiographs (5 to 1), electrocardiograms (12 to 4), and labs run (47 to 13).
Conclusion: This program and the EMR-based alerts were successful at decreasing local ED visits, annual opioid prescriptions, and hospital resource allocation for this population of patients. There is no evidence that these patients diverted their visits to neighboring EDs after being informed that they would not receive opioids at this hospital, as opioid prescriptions obtained by these patients decreased on a statewide level. This implies that individual ED protocols can have significant impact on the behavior of patients.
Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. COI summary: Paul Musey is a consultant to and has received research funding from Trevena, Inc.
References: J Emerg Trauma Shock. 2016 Apr-Jun;9(2):58-63. (PMID: 27162437)
Ann Emerg Med. 2010 Jul;56(1):42-8. (PMID: 20346540)
MMWR Morb Mortal Wkly Rep. 2015 May 1;64(16):443-4. (PMID: 25928470)
J Biomed Inform. 2009 Apr;42(2):377-81. (PMID: 18929686)
Acad Emerg Med. 2009 Oct;16(10):934-41. (PMID: 19799568)
J Emerg Med. 2008 Feb;34(2):125-9. (PMID: 17997073)
Am J Emerg Med. 2007 May;25(4):445-9. (PMID: 17499665)
Mayo Clin Proc. 2014 Apr;89(4):462-71. (PMID: 24629443)
J Emerg Nurs. 2001 Aug;27(4):327-34. (PMID: 11468626)
Am J Psychiatry. 1997 Sep;154(9):1214-9. (PMID: 9286179)
Clin Infect Dis. 2003 Dec 15;37 Suppl 5:S457-63. (PMID: 14648464)
Ann Emerg Med. 2014 Nov;64(5):469-81. (PMID: 24680237)
J Gen Intern Med. 2011 Dec;26(12):1450-7. (PMID: 21751058)
Arch Intern Med. 2012 Mar 12;172(5):405-11. (PMID: 22331982)
J Emerg Trauma Shock. 2010 Oct;3(4):326-30. (PMID: 21063553)
Am J Emerg Med. 2014 Jun;32(6):580-5. (PMID: 24726759)
N Engl J Med. 2000 Nov 2;343(18):1290-7. (PMID: 11058673)
Acad Emerg Med. 2011 Jun;18(6):e64-9. (PMID: 21676051)
JAMA. 2015 Apr 28;313(16):1636-44. (PMID: 25919527)
Med Health R I. 2011 Aug;94(8):243-4. (PMID: 21913620)
Ann Emerg Med. 2012 Jul;60(1):24-32. (PMID: 22305330)
Ann Emerg Med. 2013 Aug;62(2):151-9. (PMID: 23582617)
J Addict Dis. 2012;31(3):207-25. (PMID: 22873183)
J Emerg Med. 2014 Apr;46(4):456-64. (PMID: 23849365)
JAMA. 2000 Mar 8;283(10):1303-10. (PMID: 10714729)
Ann Emerg Med. 2014 Nov;64(5):516-25. (PMID: 24999283)
J Law Med Ethics. 2013 Mar;41 Suppl 1:42-5. (PMID: 23590739)
Pain. 2014 Dec;155(12):2673-9. (PMID: 25277462)
Virtual Mentor. 2013 May 01;15(5):410-5. (PMID: 23680561)
MMWR Morb Mortal Wkly Rep. 2016 Jan 01;64(50-51):1378-82. (PMID: 26720857)
Subst Abuse. 2009 Aug 31;3:53-60. (PMID: 24357930)
Cochrane Database Syst Rev. 2003;(2):CD002209. (PMID: 12804430)
MMWR Morb Mortal Wkly Rep. 2011 Nov 4;60(43):1487-92. (PMID: 22048730)
Pain Med. 2012 Sep;13(9):1162-73. (PMID: 22845054)
Addict Behav. 2015 Feb;41:20-8. (PMID: 25282598)
تواريخ الأحداث: Date Created: 20170907 Date Completed: 20180320 Latest Revision: 20181113
رمز التحديث: 20240829
مُعرف محوري في PubMed: PMC5576626
DOI: 10.5811/westjem.2017.6.33414
PMID: 28874942
قاعدة البيانات: MEDLINE
الوصف
تدمد:1936-9018
DOI:10.5811/westjem.2017.6.33414