دورية أكاديمية
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Effect of Changing Electronic Health Record Opioid Analgesic Dispense Quantity Defaults on the Quantity Prescribed: A Cluster Randomized Clinical Trial.

التفاصيل البيبلوغرافية
العنوان: Effect of Changing Electronic Health Record Opioid Analgesic Dispense Quantity Defaults on the Quantity Prescribed: A Cluster Randomized Clinical Trial.
المؤلفون: Bachhuber MA; Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.; Now with Section of Community and Population Medicine, Louisiana State University Health Sciences Center-New Orleans., Nash D; Institute for Implementation Science in Population Health, City University of New York, New York.; Graduate School of Public Health and Health Policy, Department of Epidemiology and Biostatistics, City University of New York, New York, New York., Southern WN; Division of Hospital Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York., Heo M; Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.; Now with College of Behavioral, Social and Health Sciences, Department of Public Health Sciences, Clemson University, Clemson, South Carolina., Berger M; Montefiore Information Technology, Montefiore Medical Center, Bronx, New York., Schepis M; Montefiore Information Technology, Montefiore Medical Center, Bronx, New York., Thakral M; College of Nursing and Health Sciences, University of Massachusetts Boston, Boston., Cunningham CO; Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
المصدر: JAMA network open [JAMA Netw Open] 2021 Apr 01; Vol. 4 (4), pp. e217481. Date of Electronic Publication: 2021 Apr 01.
نوع المنشور: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Chicago, IL : American Medical Association, [2018]-
مواضيع طبية MeSH: Electronic Health Records*, Acute Pain/*drug therapy , Analgesics, Opioid/*therapeutic use , Practice Patterns, Physicians'/*statistics & numerical data, Adult ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Primary Health Care
مستخلص: Importance: Interventions to improve judicious prescribing of opioid analgesics for acute pain are needed owing to the risks of diversion, misuse, and overdose.
Objective: To assess the effect of modifying opioid analgesic prescribing defaults in the electronic health record (EHR) on prescribing and health service use.
Design, Setting, and Participants: A cluster randomized clinical trial with 2 parallel arms was conducted between June 13, 2016, and June 13, 2018, in a large urban health care system comprising 32 primary care and 4 emergency department (ED) sites in the Bronx, New York. Data were analyzed using a difference-in-differences method from 6 months before implementation through 18 months after implementation. Data were analyzed from January 2019 to February 2020.
Interventions: A default dispense quantity for new opioid analgesic prescriptions of 10 tablets (intervention) vs no change (control) in the EHR.
Main Outcomes and Measures: The primary outcome was the quantity of opioid analgesics prescribed with the new default prescription. Secondary outcomes were opioid analgesic reorders and health service use within 30 days after the new prescription. Intention-to-treat analysis was conducted.
Results: Overall, 21 331 patients received a new opioid analgesic prescription from 490 prescribers. Comparing the intervention and control arms, site, prescriber, and patient characteristics were similar. For the new prescription, compared with the control arm, patients in the intervention arm had significantly more prescriptions for 10 tablets or fewer (7.6 percentage points; 95% CI, 6.1-9.2 percentage points), a lower number of tablets prescribed (-2.1 tablets; 95% CI, -3.3 to -0.9 tablets), and lower morphine milligram equivalents (MME) prescribed (-14.6 MME; 95% CI, -22.6 to -6.6 MME). Within 30 days after the new prescription, significant differences remained in the number of tablets prescribed (-2.7 tablets; 95% CI, -4.8 to -0.6 tablets), but not MME (-15.8 MME; 95% CI, -33.8 to 2.2 MME). Within this 30-day period, there were no significant differences between the arms in health service use.
Conclusions and Relevance: In this study, implementation of a uniform reduced default dispense quantity of 10 tablets for opioid analgesic prescriptions led to a modest reduction in the quantity prescribed initially, without significantly increasing health service use. However, during 30 days after implementation, the influence on prescribing was mixed. Reducing EHR default dispense quantities for opioid analgesics is a feasible strategy that can be widely disseminated and may modestly reduce prescribing.
Trial Registration: ClinicalTrials.gov Identifier: NCT03003832.
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معلومات مُعتمدة: K24 DA036955 United States DA NIDA NIH HHS; P30 AI124414 United States AI NIAID NIH HHS; UL1 TR002556 United States TR NCATS NIH HHS; K08 DA043050 United States DA NIDA NIH HHS; UL1 TR001073 United States TR NCATS NIH HHS
سلسلة جزيئية: ClinicalTrials.gov NCT03003832
المشرفين على المادة: 0 (Analgesics, Opioid)
تواريخ الأحداث: Date Created: 20210422 Date Completed: 20210824 Latest Revision: 20211028
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC8063068
DOI: 10.1001/jamanetworkopen.2021.7481
PMID: 33885773
قاعدة البيانات: MEDLINE
الوصف
تدمد:2574-3805
DOI:10.1001/jamanetworkopen.2021.7481