Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing

Meisenberg, Barry; Grover, Jennifer; Campbell, C.; Korpon, Daniel

doi:10.1001/jamanetworkopen.2018.2908

Cited by 101 publications

(101 citation statements)

References 30 publications

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“…If a surgeon believes that opioid dependence/abuse is not a problem, then they might choose to prescribe opioids more frequently, and vice-versa. [6][7][8] A similar survey study to this one, looking at attitudes of hand surgeons regarding opioid use, revealed that most hand surgeons (76%) felt that opioid abuse was a big/moderate problem in the hand surgery community. 9 Resultantly, almost half of the same population reported that they were less likely to prescribe opioids when compared to 1 year prior.…”

Section: Discussionmentioning

confidence: 66%

“…If a surgeon believes that opioid dependence/abuse is not a problem in that patient or patient population, then he/she might choose to prescribe opioids more frequently, and vice-versa. [6][7][8] A previous study has demonstrated that when surgeons perceive opioid abuse to be a big/moderate problem among their patients, a subsequent reduction in opioid prescription ensues. 9 While opioid prescription patterns among facial plastic surgeons after rhinoplasty have been previously reported, [2][3][4] no research has evaluated the perceptions of facial plastic surgeons on opioid dependence in the rhinoplasty population.…”

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confidence: 99%

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Perspectives of Facial Plastic Surgeons on Opioid Dependence in Rhinoplasty Patients

2019

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Understanding the perspectives and opinions of facial plastic surgeons on opioid dependence is critical in a national epidemic of opioid overuse. Findings may encourage surgeon education so that facial plastic surgeons may be able to judiciously prescribe opioids, improving patient outcomes and reducing healthcare opioid-related spending. The objective of this study is to understand facial plastic surgeons' perspectives on opioid dependence in rhinoplasty patients. A key secondary objective was to quantify facial plastic surgeons' opioid prescribing patterns. This was a prospective survey study. A nine-question survey was sent to all members of the American Academy of Facial Plastic and Reconstructive Surgery in July of 2018, and analysis of the data was completed in August of 2018. The primary study outcome measurement was surgeon perspectives on opioid dependence. This was measured by an online survey. A total of 164 facial plastic surgeons responded to the survey (response rate: 6.6%). The majority were experienced surgeons in practice for more than 10 years (61.96%) who perform less than five rhinoplasties per week (84.15%). Of the facial plastic surgeons, 89.51% prescribe some variation of opioids following rhinoplasty. Most surgeons believe that opioid dependence is not a problem in rhinoplasty patients (86.96%), but that it is a problem among surgical patients in general (61.11%). The majority (52.45%) of surgeons prescribe between 11 and 25 tablets of opioids following rhinoplasty, with 25.17% of surgeons prescribing > 25 tablets of opioids. Facial plastic surgeons do not believe opioid dependence to be a problem among rhinoplasty patients. Resultantly, many facial plastic surgeons can prescribe more than 25 tables of opioids following rhinoplasty. The findings suggest that facial plastic surgeons may require further education and complete more research regarding opioid dependence among the rhinoplasty population. Additionally, the findings are important for health policy in that they encourage the creation of rhinoplasty specific opioid prescription guidelines.

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Section: Discussionmentioning

confidence: 66%

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confidence: 99%

Perspectives of Facial Plastic Surgeons on Opioid Dependence in Rhinoplasty Patients

2019

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“…Our findings provide priority areas that clinicians, policymakers, medicine regulators, and commissioners can use in their plight to manage the growing opioid crisis. Monitoring the prescribing of opioids via clinical dashboards or electronic medical records has improved adherence to guidelines, reduced opioid doses, and improved physicians' knowledge and attitudes towards managing people on opioids in primary care [40][41][42]. Strategies that promote the safe prescribing of opioids and enable prescribers to effectively manage factors such as benzodiazepine co-prescription and depression are needed.…”

Section: Implications For Practice and Policymentioning

confidence: 99%

Factors associated with the prescribing of high-dose opioids in primary care: a systematic review and meta-analysis

Richards

Mahtani

Muthee

et al. 2020

BMC Med

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Background: The risks of harms from opioids increase substantially at high doses, and high-dose prescribing has increased in primary care. However, little is known about what leads to high-dose prescribing, and studies exploring this have not been synthesized. We, therefore, systematically synthesized factors associated with the prescribing of high-dose opioids in primary care. Methods:We conducted a systematic review of observational studies in high-income countries that used patientlevel primary care data and explored any factor(s) in people for whom opioids were prescribed, stratified by oral morphine equivalents (OME). We defined high doses as ≥ 90 OME mg/day. We searched MEDLINE, Embase, Web of Science, reference lists, forward citations, and conference proceedings from database inception to 5 April 2019. Two investigators independently screened studies, extracted data, and appraised the quality of included studies using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. We pooled data on factors using random effects meta-analyses and reported relative risks (RR) or mean differences with 95% confidence intervals (CI) where appropriate. We also performed a number needed to harm (NNT H ) calculation on factors when applicable. Results:We included six studies with a total of 4,248,119 participants taking opioids, of whom 3.64% (n = 154,749) were taking high doses. The majority of included studies (n = 4) were conducted in the USA, one in Australia and one in the UK. The largest study (n = 4,046,275) was from the USA. Included studies were graded as having fair to good quality evidence. The co-prescription of benzodiazepines (RR 3.27, 95% CI 1.32 to 8.13, I 2 = 99.9%), depression (RR 1.38, 95% CI 1.27 to 1.51, I 2 = 0%), emergency department visits (RR 1.53, 95% CI 1.46 to 1.61, I 2 = 0%, NNT H 15, 95% CI 12 to 20), unemployment (RR 1.44, 95% CI 1.27 to 1.63, I 2 = 0%), and male gender (RR 1.21, 95% CI 1.14 to 1.28, I 2 = 78.6%) were significantly associated with the prescribing of high-dose opioids in primary care.Conclusions: High doses of opioids are associated with greater risks of harms. Associated factors such as the coprescription of benzodiazepines and depression identify priority areas that should be considered when selecting, identifying, and managing people taking high-dose opioids in primary care. Coordinated strategies and services that promote the safe prescribing of opioids are needed. Study registration: PROSPERO, CRD42018088057

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“…29 Recently, mandatory prescription limits have been associated with a reduction of opioid use after elective surgeries. [30][31][32][33] However, our knowledge of the potential strategies is limited, and none are currently broadly applied as standard of care interventions. The objective of our scoping review is to understand the strategies aiming at preventing chronic opioid use specific to adult trauma and acute care surgery patients.…”

Section: Open Accessmentioning

confidence: 99%

Strategies aimed at preventing chronic opioid use in trauma and acute care surgery: a scoping review protocol

et al. 2020

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IntroductionGlobally every year, millions of patients sustain traumatic injuries and require acute care surgeries. A high incidence of chronic opioid use (up to 58%) has been documented in these populations with significant negative individual and societal impacts. Despite the importance of this public health issue, optimal strategies to limit the chronic use of opioids after trauma and acute care surgery are not clear. We aim to identify existing strategies to prevent chronic opioid use in these populations.Methods and analysisWe will perform a scoping review of peer-reviewed and non-peer-reviewed literature to identify studies, reviews, recommendations and guidelines on strategies aimed at preventing chronic opioid use in patients after trauma and acute care surgery. We will search MEDLINE, EMBASE, PsycINFO, CINHAL, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest and websites of trauma and acute care surgery, pain, government and professional organisations. Databases will be searched for papers published from 1 January 2005 to a maximum of 6 months before submission of the final manuscript. Two reviewers will independently evaluate studies for eligibility and extract data from included studies using a standardised data abstraction form. Preventive strategies will be classified according to their types and targeted trauma populations and acute care surgery procedures.Ethics and disseminationResearch ethics approval is not required as this study is based on the secondary use of published data. This work will inform research and clinical stakeholders on the required next steps towards the uptake of effective strategies aimed at preventing chronic opioid use in trauma and acute care surgery patients.

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Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing

Cited by 101 publications

References 30 publications

Perspectives of Facial Plastic Surgeons on Opioid Dependence in Rhinoplasty Patients

Perspectives of Facial Plastic Surgeons on Opioid Dependence in Rhinoplasty Patients

Factors associated with the prescribing of high-dose opioids in primary care: a systematic review and meta-analysis

Strategies aimed at preventing chronic opioid use in trauma and acute care surgery: a scoping review protocol

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