The Effect of Teaching Clinics on Prescribing Practices

Alleyne, Jennifer E.; Bashir, Ahmad S.; Birdwhistell, Meredith L.; McDonald, Colin; Nguyen, T. T.H.; Partin, David J.; Siscoe, Kimberly S.; Sonderman, Nichole L.; Wichmann, G; Spurgeon, Joyce; El‐Mallakh, Rif S.; Vincent, Kathy

doi:10.1007/s40596-015-0385-y

Cited by 3 publications

(4 citation statements)

References 3 publications

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“…In our study, residents/fellows were responsible for 26% of prescriptions. This is consistent with prior literature, showing that residents assume major roles in prescribing patterns in educational settings . The larger quantities of MMEs prescribed by residents reinforce the need for targeted interventions to involve trainee education.…”

Section: Discussionsupporting

confidence: 89%

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EMR quantity autopopulation removal on hospital discharge prescribing patterns: Implications for opioid stewardship

Villwock

New

et al. 2019

J Clin Pharm Ther

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What is Known and Objective: Prescription drug stewardship is critical. Autopopulation(AP) of medication quantities may influence prescriber behaviour. We investigate the impact of AP removal(APR) on opioid prescribing. Methods: Inpatient and emergency department(ED) discharges with opioid pain medications 2 years before and after APR were identified. Milligrams of morphine equivalents(MMEs) prescribed were recorded. Group comparisons were performed using Mann-Whitney U tests. Spearman's rho was used to analyse correlations between pain level and quantity of prescribed opioids. Mann-Kendall tests assessed trends in prescription patterns. Generalized estimating equations assessed trends in total quantity of prescribed MME. Results and Discussion: A total of 53 608 patient encounters were included for analysis. In surgical patients, there were no trends in the frequency of prescriptions below, at or above the AP quantity pre-APR. Post-APR, there was a decrease in the percentage of prescriptions written for the AP quantity(τ = −.493, P = .001) and an increase in prescriptions for <30 tablets(τ = .468,P = .001). In non-operative patients, the pre-APR period was associated with a lower percentage of prescriptions >30 tablets and a greater percentage of prescriptions for <30 tablets. Interestingly, APR reversed this trend in prescriptions for >30 tablets and resulted in an increase in larger prescriptions. Multivariate analysis of the total prescribed quantity of MME found no significant trend across months for inpatients prior to and after APR (0.997, P = .065 and 1.003, P = .142; respectively). The ED model found a monthly downward trend in amount of prescribed MME prior to and after APR (0.986, P < .001 and 0.990, P < .001; respectively). In the inpatient setting, pain was positively correlated to discharge MME (ρ = .028, P < .001); with those reporting the highest pain receiving the greatest amount of opioids both pre-and post-APR. Interestingly, in the ED, this finding was negatively correlated (ρ = −.086, P < .001); with those reporting the lowest pain receiving the greatest amount of opioids both pre-and post-APR. What is New and Conclusions: AP removal may have unintended consequences, such as increased prescriptions for greater quantities. To drive down prescription amounts, lower anchor values may be of more utility than APR. The poor correlation of pain values with prescribed medications warrants further investigation.

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Section: Discussionsupporting

confidence: 89%

“…showing that residents assume major roles in prescribing patterns in educational settings. 26 The larger quantities of MMEs prescribed by residents reinforce the need for targeted interventions to involve trainee education. However, attending physicians must also be engaged in, and support, these processes.…”

Section: Discussionmentioning

confidence: 99%

EMR quantity autopopulation removal on hospital discharge prescribing patterns: Implications for opioid stewardship

Villwock

New

et al. 2019

J Clin Pharm Ther

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“…Previous study had suggested that this was a reasonable measure of clinical decision-making. 14 In our quality assurance examination, clinicians, were equally likely to act on their collected clinical data by ordering a medication change if they saw their patient virtually or in person. This suggests that remote assessments yielded similar conclusions to in-person assessments, even in patients who do not voluntarily participate in a telehealth study.…”

Section: Discussionmentioning

confidence: 99%

“…We examined the rate of medication changes during virtual and in-person visits as a proxy for the equivalence of clinical decision-making because this method was utilized previously. 14 All patients were ≥18 years. We identified times when patients came to two consecutive visits with the same provider and the same primary diagnosis and evaluated treatment changes on the second visit.…”

Section: Methodsmentioning

confidence: 99%

Frequency of Modification of Pharmacological Treatment Is Equivalent for Virtual and In-Person Psychiatric Visits

Mumtaz

Adigun

El‐Mallakh

2023

Telemedicine Reports

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Background: During the coronavirus pandemic there was a rapid adoption of telehealth services in psychiatry, which now accounts for 40% of all visits. There is a dearth of information about the relative efficacy of virtual and in-person psychiatric evaluations. Methods: We examined the rate of medication changes during virtual and in-person visits as a proxy for the equivalence of clinical decision-making. Results: A total of 280 visits among 173 patients were evaluated. The majority of these visits were telehealth (224, 80%). There were 96 medication changes among the telehealth visits (42.8%) and 21 among the in-person visits (37.5%) ( z = −1.4, p = 0.16). Conclusion: Clinicians were equally as likely to order a medication change if they saw their patient virtually or in person. This suggests that remote assessments yielded similar conclusions to in-person assessments.

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Prevalence and predictors of physician recommendations for medication adjustment in bipolar disorder treatment

Hodgkin

Stewart

Merrick

et al. 2018

Journal of Affective Disorders

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The Effect of Teaching Clinics on Prescribing Practices

Abstract: Residents, not the attending physicians, are more instrumental in medication changes in patients attending an education clinic.

Cited by 3 publications

References 3 publications

EMR quantity autopopulation removal on hospital discharge prescribing patterns: Implications for opioid stewardship

EMR quantity autopopulation removal on hospital discharge prescribing patterns: Implications for opioid stewardship

Frequency of Modification of Pharmacological Treatment Is Equivalent for Virtual and In-Person Psychiatric Visits

Prevalence and predictors of physician recommendations for medication adjustment in bipolar disorder treatment

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