Controlled substance e-prescribing now legal in all 50 states

Bonner, Loren

doi:10.1016/j.ptdy.2015.12.019

Cited by 4 publications

(8 citation statements)

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“…The importance of this study is that it demonstrates that opioid needs for neck dissections performed for thyroid cancer are minimal, unlike those for resection of other malignant head and neck diseases, and that surgeons can curtail opioid prescribing for these patients. Based these study findings and that electronic prescribing of controlled substances is now allowed in 50 US states, we recommend that patients who did not need any opioids during their hospitalization be discharged with minimal (<125 MME) or no opioid medication when it can be prescribed electronically if needed.…”

Section: Discussionmentioning

confidence: 92%

Association of a Multimodal Intervention With Decreased Opioid Prescribing After Neck Dissection for Malignant Thyroid Disease With Short Hospital Stay

March

Lim

Manzione

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEPrescribing practices for opioid medication after thyroid surgery have been well-studied and established; however, the need for pain management with opioid medication following lateral neck dissection for malignant thyroid disease with a short hospital stay has not been established. OBJECTIVE To evaluate a multimodal opioid reduction intervention and its association with a decrease in prescribing of opioid medication at hospital discharge for patients after a lateral neck dissection for thyroid cancer. DESIGN, SETTING, AND PARTICIPANTSThis was a retrospective cohort study of patients treated from 2011 to 2021 by a tertiary academic institution that performs a high volume of thyroid cancer surgeries annually. We evaluated the electronic health records of 417 patients who had undergone lateral neck dissection for malignant thyroid disease from June 1, 2011, to June 30, 2021, and had a short hospital stay (Յ3 days). Patients with longer stays (>3 days) or additional surgical procedures were excluded. Group 1 comprised patients who underwent a neck dissection before the intervention; and group 2, those who underwent the procedure after implementation of the intervention.INTERVENTION A multimodal intervention composed of 3 components to reduce opioid prescribing at hospital discharge home after neck dissection for malignant thyroid disease with a short hospital stay. MAIN OUTCOMES AND MEASURESThe primary outcome was the quantity of opioid medication prescribed in the postoperative period, measured as oral morphine milliequivalents (MME). The eta-squared effect size (η 2 ES) metric was used to determine the association of the intervention with a reduction in the MME quantities of opioid medication administered to inpatients and prescribed at discharge. An estimated need for opioids was established for the average patient undergoing lateral neck dissection for thyroid cancer based on the upper range of prescribing after intervention. The data were analyzed from January to March 2022. RESULTSThe total study population was 417 patients: group 1 with 171 patients (mean [SD] age , 47.1 [15.6] years; 104 [61%] women; 144 [84%] non-Hispanic White) and group 2 with 246 patients (mean [SD] age , 46.2 [17.4] years; 146 [60%] women; 206 [83.7%]non-Hispanic White). The median MME prescribed at discharge for group 1 per patient was 225 MME compared with 0 MME for group 2, a large effect-size difference. There was a moderate association between the dose amount administered to an inpatient and the prescription dose they received at discharge (r, 0.33). Multiple linear regression analysis of sex, age, race and ethnicity, extent of surgery, and opioid reduction intervention showed that the intervention had a large clinically meaningful association with decreasing opioid prescriptions and dosage amounts at discharge (η 2 ES, 0.26; 95% CI, 0.19-0.33). CONCLUSIONS AND RELEVANCEThe findings of this retrospective cohort study suggest that patients undergoing lateral neck dissections for thyroid cancer with short hospitalization ...

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Section: Discussionmentioning

confidence: 92%

Association of a Multimodal Intervention With Decreased Opioid Prescribing After Neck Dissection for Malignant Thyroid Disease With Short Hospital Stay

March

Lim

Manzione

et al. 2022

JAMA Otolaryngol Head Neck Surg

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“…During the study time frame, this institution printed all controlled substance prescriptions at discharge, though controlled substance e-prescriptions are now legal in all states. 22 Although medications for secondary prevention were significantly more likely to be filled within 30 days, each of the 4 drug classes within this group still had sizable nonfill rates. Given the serious short-term consequences of nonadherence such as in-stent thrombosis, all evidenced-based therapies for the after-revascularization population should be strongly encouraged.…”

Section: Patient-level Demographics and Visit Characteristics By Noninitiation Statusmentioning

confidence: 87%

Noninitiation of Discharge Medications After Revascularization

Medaglio

Glasgow

Zhang

et al. 2020

JMCP

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BACKGROUND: Timely initiation of medication therapy after a cardiovascular event is vital to achieve optimal patient outcomes, yet there is a lack of insight on the frequency and predictors of discharge medications that are delayed or never initiated.OBJECTIVES: To (a) describe how frequently patients do not fill newly prescribed discharge medications within 30 days after revascularization and (b) identify predictors of patients who did not fill their new medications.METHODS: A single-center, retrospective analysis was conducted of patients discharged after percutaneous coronary intervention or coronary artery bypass grafting. Discharge prescriptions were linked to pharmacy claims data to identify medications that were not filled within 30 days of discharge.RESULTS: 1,206 patients and their 5,253 discharge medications were included for study. More than one third of patients did not fill at least 1 discharge medication within 30 days (466/1,206, 38.6%); nearly 1 in 10 (116/1,206, 9.6%) did not fill any of their discharge prescriptions. Significant predictors of nonadherence included longer length of stay and higher number of prescribed discharge medications (both P values < 0.05). The largest classes of unfilled medications included insulin, factor Xa inhibitors, and narcotic analgesics. CONCLUSIONS: Noninitiation is a common issue among patients after cardiac revascularization. These patients may be at a higher risk of not filling their medications if they experience longer lengths of stay or are prescribed a higher number of medications at discharge.

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“…All 50 US states have laws that authorize pharmacists to develop CPAs with physicians and other clinicians [15]. In Connecticut, physician-pharmacist CPAs began in 2012 with expansion to APRNs in 2019.…”

Section: Pcp Perspectives On Use Of Cpasmentioning

confidence: 99%

“…PCPs in larger practices and less than 16 years of practice experience agreed that a community pharmacist working with a CPA would decrease their clinical workload burden. CPAs clearly specify functions that are delegated to the pharmacist (e.g., initiating or modifying medications, ordering/interpreting lab tests) [15] and can free up PCP time. It is estimated that PCPs spend approximately 37% of their time on activities related to chronic care management, which often includes managing complex medication regimens [35].…”

Section: Pcp Perspectives On Use Of Cpasmentioning

confidence: 99%

“…Beyond traditional dispensing roles, many community pharmacists have clinical training and professional expertise to collaborate with PCPs as extended primary care team members to resolve medication-related clinical challenges, optimize complex medication regimens, and enhance patient outcomes [12][13][14]. All 50 US states permit pharmacists to develop Collaborative Practice Agreements (CPAs) with physicians and other clinicians [15].…”

Section: Introductionmentioning

confidence: 99%

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Improving Collaboration between Primary Care Providers and Community Pharmacists: A CrossSectional Survey

2024

J Family Med Prim Care Open Acc

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Introduction: Community pharmacists are highly trained and accessible health professionals. Over 95% of the US public is within 10 miles of a community pharmacy. This study characterizes current community pharmacist-primary care provider (PCP) communications, and PCP perspectives on establishing medication-related services and collaborative practice agreements (CPAs) with community pharmacists to improve public health. Methods: PCPs responded to an online, cross-sectional survey from December 2020 to January 2021. Results: Of 222 PCP respondents, nearly 50% of PCPs or staff members communicated weekly with community pharmacists about prescriptions, and 66% of PCPs were not aware of community pharmacists' capabilities to monitor and manage medications. Only 31% of PCPs were aware that community pharmacists use Collaborative Practice Agreements (CPA). PCPs with less than 16 years of practice experience agreed that community pharmacists working with a CPA could decrease their clinical workload burden. Facilitators of PCP support for community pharmacists providing medication monitoring and management services included positive patient feedback, patient outcome improvement, and patient perception of the community pharmacist as a primary care team member. PCP perceived barriers were the lack of PCP knowledge of community pharmacist clinical training, no dedicated pharmacist time to provide direct patient care services, minimal pharmacist experience in providing medication monitoring and management, and poor documentation of community pharmacist services in electronic health records. Conclusion: Opportunities exist for greater community pharmacist-PCP collaboration to improve chronic disease patient outcomes. Given their public accessibility, community pharmacist medication monitoring and management services should be considered to improve public health.

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Controlled substance e-prescribing now legal in all 50 states

Cited by 4 publications

References 0 publications

Association of a Multimodal Intervention With Decreased Opioid Prescribing After Neck Dissection for Malignant Thyroid Disease With Short Hospital Stay

Association of a Multimodal Intervention With Decreased Opioid Prescribing After Neck Dissection for Malignant Thyroid Disease With Short Hospital Stay

Noninitiation of Discharge Medications After Revascularization

Improving Collaboration between Primary Care Providers and Community Pharmacists: A CrossSectional Survey

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