Impact of policy-based and institutional interventions on postoperative opioid prescribing practices

Titan, Ashley L.; Doyle, Alexis; Pfaff, Kayla E.; Baiu, Ioana; Lee, Angela; Graham, Laura A.; Shelton, Andrew; Hawn, Mary T.

doi:10.1016/j.amjsurg.2021.02.004

Cited by 7 publications

(5 citation statements)

References 37 publications

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“…Importantly, patient-reported pain and surrogate markers of pain management were not impacted by the decrement in post-op opioid prescribing, likely due to historical over prescription of opioids. This is consistent with existing literature demonstrating that efforts to decrease over prescribing have not led to significant increases in refill requests ( Titan et al, 2021 , Stanek et al, 2015 ). In fact, in some studies, more restrictive opioid prescription policies were associated with fewer refill requests ( Zsiros et al, 2023 ).…”

Section: Discussionsupporting

confidence: 92%

Implementation of a validated post-operative opioid nomogram into clinical gynecologic surgery practice: A quality improvement initiative

Zanolli,

Lim,

Knechtle

et al. 2023

Gynecologic Oncology Reports

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Section: Discussionsupporting

confidence: 92%

Implementation of a validated post-operative opioid nomogram into clinical gynecologic surgery practice: A quality improvement initiative

Zanolli,

Lim,

Knechtle

et al. 2023

Gynecologic Oncology Reports

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“…Previous studies in this field examined preimplementation data for only 10 months or less of prescribing. 18 , 20 , 22 , 26 Furthermore, 3 studies included only 1 surgical specialty, 18 , 20 , 23 and 1 study examined a pediatric population. 22 Strengths of our study compared with previous work include a large EHR-based data set from 24 hospitals and numerous surgical specialties during a period of 5 years.…”

Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Although most studies examining the consequences of mandated PDMP consultation have reported an associated reduction in opioid prescribing, the data have been mixed. 18 , 19 , 20 , 21 , 22 , 23 Few studies have focused on postoperative prescribing despite the fact that 80% of patients receive an opioid analgesic medication for pain management after surgery. 24 , 25 Among studies that have examined postoperative prescribing, the focus has been on changes within 1 year, 26 within a single specialty, 18 , 20 , 23 or within pediatric populations.…”

Section: Introductionmentioning

confidence: 99%

“… 18 , 19 , 20 , 21 , 22 , 23 Few studies have focused on postoperative prescribing despite the fact that 80% of patients receive an opioid analgesic medication for pain management after surgery. 24 , 25 Among studies that have examined postoperative prescribing, the focus has been on changes within 1 year, 26 within a single specialty, 18 , 20 , 23 or within pediatric populations. 22 We examined 5 years of electronic health record (EHR) data from before and after the implementation of mandated CURES consultation prompted by an EHR-based alert.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Postoperative Opioid Prescriptions Before and After Implementation of a Mandatory Prescription Drug Monitoring Program

et al. 2021

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IMPORTANCE Legislation mandating consultation with a prescription drug monitoring program (PDMP) was implemented in California on October 2, 2018. This mandate requires PDMP consultation before prescribing a controlled substance and integrates electronic health record (EHR)-based alerts; prescribers are exempt from the mandate if they prescribe no more than a 5-day postoperative opioid supply. Although previous studies have examined the consequences of mandated PDMP consultation, few have specifically analyzed changes in postoperative opioid prescribing after mandate implementation. OBJECTIVE To examine whether the implementation of mandatory PDMP consultation with concurrent EHR-based alerts was associated with changes in postoperative opioid quantities prescribed at discharge. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study performed an interrupted time series analysis of opioid prescribing patterns within a large health care system (Sutter Health) in northern California between January 1, 2015, and February 1, 2020. A total of 93 760 adult patients who received an opioid prescription at discharge after undergoing general, obstetric and gynecologic (obstetric/gynecologic), or orthopedic surgery were included. EXPOSURES Mandatory PDMP consultation before opioid prescribing, with concurrent integration of an EHR alert. Prescribers are exempt from this mandate if prescribing no more than a 5-day opioid supply postoperatively. MAIN OUTCOMES AND MEASURESThe primary outcome was the total quantity of opioid medications (morphine milligram equivalents [MMEs] and number of opioid tablets) prescribed at discharge before and after implementation of the PDMP mandate, with separate analyses by surgical specialty (general, obstetric/gynecologic, and orthopedic) and most common surgical procedure within each specialty (laparoscopic cholecystectomy, cesarean delivery, and knee arthroscopy). The secondary outcome was the proportion of prescriptions with a duration of longer than 5 days. RESULTSOf 93 760 patients (mean [SD] age, 46.7 [17.6] years; 67.9% female) who received an opioid prescription at discharge, 65 911 received prescriptions before PDMP mandate implementation, and 27 849 received prescriptions after implementation. Most patients received general or obstetric/gynecologic surgery (48.6% and 30.1%, respectively), did not have diabetes (90.3%), and had never smoked (66.0%). Before the PDMP mandate was implemented, a decreasing pattern in opioid prescribing quantities was already occurring. During the quarter of implementation, total MMEs prescribed at discharge further decreased for all 3 surgical specialties

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Doing our part to address the opioid epidemic

Thomas

Stey

2022

The American Journal of Surgery

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Impact of policy-based and institutional interventions on postoperative opioid prescribing practices

Cited by 7 publications

References 37 publications

Implementation of a validated post-operative opioid nomogram into clinical gynecologic surgery practice: A quality improvement initiative

Implementation of a validated post-operative opioid nomogram into clinical gynecologic surgery practice: A quality improvement initiative

Assessment of Postoperative Opioid Prescriptions Before and After Implementation of a Mandatory Prescription Drug Monitoring Program

Doing our part to address the opioid epidemic

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