Opioid Prescription Reduction After Implementation of a Feedback Program in a National Emergency Department Group

Oskvarek, Jonathan J.; Aldeen, Amer Z.; Shawbell, Jason; Venkat, Arvind; Zocchi, Mark S.; Pines, Jesse M.

doi:10.1016/j.annemergmed.2021.12.009

Cited by 2 publications

(2 citation statements)

References 31 publications

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“…26 A US study set in emergency departments in 2021 provided clinician feedback in the form of dashboards showing comparisons with their peers and advice via emails from clinical leaders for those with the highest prescribing of opioids. 48 The intervention resulted in a 19% relative reduction in patients discharged on opioids. A separate study, undertaken in US emergency department settings in 2019-2020, compared peer comparison feedback alone or combined with individual audit and feedback with individual audit and feedback alone.…”

Section: Discussionmentioning

confidence: 99%

“…A 2020 systematic review on interventions to improve opioid use for chronic non-cancer pain identified two randomised controlled trials and five observational studies that had assessed change in opioid use as a result of the intervention, with two studies reporting the results of audit and feedback, finding on average a 20.32 mg morphine equivalent dose reduction 26. A US study set in emergency departments in 2021 provided clinician feedback in the form of dashboards showing comparisons with their peers and advice via emails from clinical leaders for those with the highest prescribing of opioids 48. The intervention resulted in a 19% relative reduction in patients discharged on opioids.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reducing opioid use for chronic non-cancer pain in primary care using an evidence-based, theory-informed, multistrategic, multistakeholder approach: a single-arm time series with segmented regression

et al. 2023

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BackgroundMany countries have high opioid use among people with chronic non-cancer pain. Knowledge about effective interventions that could be implemented at scale is limited. We designed a national intervention that included audit and feedback, deprescribing guidance, information on catastrophising assessment, pain neuroscience education and a cognitive tool for use by patients with their healthcare providers.MethodWe used a single-arm time series with segmented regression to assess rates of people using opioids before (January 2015 to September 2017), at the time of (October 2017) and after the intervention (November 2017 to August 2019). We used a cohort with historical comparison group and log binomial regression to examine the rate of psychologist claims in opioid users not using psychologist services prior to the intervention.Results13 968 patients using opioids, 8568 general practitioners, 8370 pharmacies and accredited pharmacists and 689 psychologists were targeted. The estimated difference in opioid use was −0.51 persons per 1000 persons per month (95% CI −0.69, –0.34; p<0.001) as a result of the intervention, equating to 25 387 (95% CI 24 676, 26 131) patient-months of opioid use avoided during the 22-month follow-up. The targeted group had a significantly higher rate of incident patient psychologist claims compared with the historical comparison group (rate ratio: 1.37, 95% CI 1.16, 1.63; p<0.001), equating to an additional 690 (95% CI 289, 1167) patient-months of psychologist treatment during the 22-month follow-up.ConclusionsOur intervention addressed the cognitive, affective and sensory factors that contribute to pain and consequent opioid use, demonstrating it could be implemented at scale and was associated with a reduction in opioid use and increasing utilisation of psychologist services.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%