Dataset Information

Opioid prescribing trends in a Veterans Affairs emergency department and dental clinic before and after implementation of opioid-prescribing guidelines.

ABSTRACT: Introduction:Opioid overdose is highly prevalent among veterans. The Opioid Safety Initiative (OSI) and Centers for Disease Control and Prevention (CDC) issued prescribing guidelines for managing chronic pain. The purpose of this study was to investigate the impact of the 2013 OSI and 2016 CDC guidelines on opioid-prescribing trends in the emergency department and dental clinic within the Veterans Affairs Salt Lake City Health Care System. Methods:In this retrospective, cohort study, opioid prescriptions were queried from January 1, 2013, through March 31, 2017, and separated into 3 groups: pre-OSI, post-OSI, and post-CDC. The primary outcome was to determine a decrease in opioid prescribing. Secondary outcomes included changes in concurrent benzodiazepine and naloxone prescriptions and prescriber status. Analysis of variance was used to determine a difference between study periods. Results:There were 7339 opioid prescriptions identified. A statistically significant difference was found between the 3 groups in average number of opioids prescribed, morphine milligram equivalents per prescription, days' supplied, and medication quantity per prescription (P?

SUBMITTER: Lavasani R

PROVIDER: S-EPMC7534812 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Opioid prescribing trends in a Veterans Affairs emergency department and dental clinic before and after implementation of opioid-prescribing guidelines.

Lavasani Rebecca R Chung Michelle M Beatty Allison A Lawrence Phillip P Unni Elizabeth E

The mental health clinician 20200930 5

<h4>Introduction</h4>Opioid overdose is highly prevalent among veterans. The Opioid Safety Initiative (OSI) and Centers for Disease Control and Prevention (CDC) issued prescribing guidelines for managing chronic pain. The purpose of this study was to investigate the impact of the 2013 OSI and 2016 CDC guidelines on opioid-prescribing trends in the emergency department and dental clinic within the Veterans Affairs Salt Lake City Health Care System.<h4>Methods</h4>In this retrospective, cohort stu ...[more]

PMID: 33062552

Similar Datasets

Project description:ObjectiveAt our emergency department (ED), opioid prescribing guidelines were implemented in September 2016. The opioid prescribing guidelines were adopted and revised from collective efforts and advocacy of the Michigan College of Emergency Physicians for ED-led opioid stewardship. We performed a retrospective before and after study to determine if opioid prescribing guidelines would change the use of intravenous opioids per patient and the morphine equivalent units (MEU) per patient in a suburban academic ED.MethodsA retrospective observational study was conducted at a tertiary care level 1 trauma center with an annual ED volume of ≈ 130,000 visits. All intravenous orders of fentanyl, morphine, and hydromorphone for adult patients from January 1, 2015, through December 31, 2017, were tabulated. A 3-month (August 2016-October 2016) washout period was used. Poisson and ordinary linear regression analyses were employed to evaluate any difference in number of intravenous opioids ordered before and after adoption of the guidelines. Within our opioid prescribing guidelines was also guidance for oral opioid orders within the ED and oral opioid prescriptions for discharge, although these elements were not included in this investigation.ResultsA total of 108,327 intravenous opioid orders were included in the final analysis. After adoption of the opioid prescribing guidelines, the expected number of intravenous opioids ordered dropped by 3.1% (eβ, 0.969; 95% confidence interval [CI], 0.779-1.209), and there was an additional decrease of 0.1% per month (eβ, 0.999; 95% CI, 0.990-1.010). After the adoption of opioid prescribing guidelines, the average MEU dropped by 0.3 mg (95% CI, -0.47 to -0.13), and there was decrease of 0.01 mg per month (95% CI, -0.02 to -0.004).ConclusionAfter the adoption of opioid prescribing guidelines, our analysis suggests that opioid prescribing guidelines are associated with clinically small but statistically significant changes in MEU ordered in ED. We cannot determine if this represented a continued trend of decreased opioid use or associated with the opioid prescribing guidelines.

Project description:Ethnic minority patients receive lower priority triage assignments in Veteran's Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment.The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses.A total of 359,642?patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, <1% American Indian/Alaska Native, and 1% mixed ethnicity. After controlling for demographic characteristics of nurses and patients, African-American, Hispanic, and mixed-ethnicity patients reported higher average PI scores but lower HRs and RRs than NHW patients. NHW patients received higher priority ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans).This study provides evidence for systemic differences in how patients' vital signs are applied for determining ESI scores for different ethnic groups. Additional prospective research will be needed to determine how this specific person-level mechanism affects healthcare quality and outcomes.

Project description:STUDY OBJECTIVE:We assess whether an automated prescription drug monitoring program intervention in emergency department (ED) settings is associated with reductions in opioid prescribing and quantities. METHODS:We performed a retrospective cohort study of ED visits by Medicaid beneficiaries. We assessed the staggered implementation (pre-post) of automated prescription drug monitoring program queries at 86 EDs in Washington State from January 1, 2013, to September 30, 2015. The outcomes included any opioid prescribed within 1 day of the index ED visit and total dispensed morphine milligram equivalents. The exposure was the automated prescription drug monitoring program query intervention. We assessed program effects stratified by previous high-risk opioid use. We performed multiple sensitivity analyses, including restriction to pain-related visits, restriction to visits with a confirmed prescription drug monitoring program query, and assessment of 6 specific opioid high-risk indicators. RESULTS:The study included 1,187,237 qualifying ED visits (898,162 preintervention; 289,075 postintervention). Compared with the preintervention period, automated prescription drug monitoring program queries were not significantly associated with reductions in the proportion of visits with opioid prescribing (5.8 per 1,000 encounters; 95% confidence interval [CI] -0.11 to 11.8) or the amount of prescribed morphine milligram equivalents (difference 2.66; 95% CI -0.15 to 5.48). There was no evidence of selective reduction in patients with previous high-risk opioid use (1.2 per 1,000 encounters, 95% CI -9.5 to 12.0; morphine milligram equivalents 1.22, 95% CI -3.39 to 5.82). The lack of a selective reduction in high-risk patients was robust to all sensitivity analyses. CONCLUSION:An automated prescription drug monitoring program query intervention was not associated with reductions in ED opioid prescribing or quantities, even in patients with previous high-risk opioid use.

Dataset Information

Opioid prescribing trends in a Veterans Affairs emergency department and dental clinic before and after implementation of opioid-prescribing guidelines.

Publications

Opioid prescribing trends in a Veterans Affairs emergency department and dental clinic before and after implementation of opioid-prescribing guidelines.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets