Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing
Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing
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DOI：
10.1001/jamanetworkopen.2018.2908
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发表时间：
2018-09-01
影响因子：
13.8
通讯作者：
Korpon, Daniel
中科院分区：
文献类型：
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作者：
Meisenberg, Barry R.;Grover, Jennifer;Korpon, Daniel
阿片类药物的过度处方已经产生并维持了阿片类药物过量的流行。卫生系统有责任带头努力，以减少overprescribing.ObjectiveTo衡量多层次干预措施对阿片类药物处方的影响within a health system.DESIGN，SETTING，AND PARTICIPANTS质量改善研究比较6个月的干预前基线与16个月的干预后期间结束于2018年4月。区域卫生系统内的住院和门诊临床活动，包括急性护理医院、当日手术和门诊诊所。使用卫生系统的电子病历测量了数百名临床医生涉及超过一百万次临床接触的阿片类药物处方活动。干预不同领域的多种平行干预措施，包括处方者教育和问责制，通过测量个体处方者加强监督，术后出院处方的正确大小工具，减少标准阿片类药物处方订单的默认金额，主要结果和措施吗啡毫克当量（MME）每月每次遭遇。每例阿片类药物处方的MME和阿片类药物处方率（每月每次就诊的阿片类药物处方）。所有基线趋势均与0无显著差异。每次就诊的卫生系统MME总数每月减少1.0 MME。在干预后观察期结束时，每月每次就诊的MME比6个月基线的平均值低58%，每月每次阿片类药物处方的MME比基线的平均值低34%，阿片类药物处方率为38%结论和相关性阿片类药物过量处方减少了针对患者和公众的多焦点干预措施要求，建立处方意识和问责制，并为临床领导问责制创建工具。大多数有组织的卫生系统都可以采用所述的干预措施。负有保护和改善公众健康使命的人应高度重视减少社区内类阿片供应总量。
IMPORTANCE Overprescribing of opioids has generated and sustains the opioid overdose epidemic. Health systems have a responsibility to lead the effort to reduce overprescribing.OBJECTIVE To measure the effects of multilevel interventions on opioid prescribing within a health system.DESIGN, SETTING, AND PARTICIPANTS Quality improvement study comparing a 6-month preintervention baseline with a 16-month postintervention period ending in April 2018. Inpatient and outpatient clinical activity within a regional health system including an acute care hospital, same-day surgery, and outpatient clinics. Opioid prescribing activity by hundreds of clinicians involving over a million clinical encounters was measured using a health system's electronic medical record.INTERVENTIONS Multiple parallel interventions in different domains, including prescriber education and accountability, enhanced oversight via measurement of individual prescribers, tools to right-size postoperative discharge prescriptions, reduction of default amounts on standard opioid prescription orders, and professionally written patient and public education about opioid risks and alternatives.MAIN OUTCOMES AND MEASURES Morphine milligram equivalents (MME) per encounter per month. MME per opioid prescription, and rate of opioid prescriptions (opioid prescriptions per encounter per month).RESULTS More than 44 000 clinical encounters per month were recorded. All baseline trends were not significantly different from 0. Total health system MME per encounter decreased 1.0 MME per encounter per month. At the end of the postintervention observation period, the monthly MME per encounter was 58% lower than the average of the 6-month baseline, the MME per opioid prescription per month was 34% less than the average of the baseline, and the opioid prescription rate was 38% lower than the average of the baseline.CONCLUSIONS AND RELEVANCE Opioid overprescribing was reduced with multifocal interventions targeting patient and public demand, creating prescriber awareness and accountability, and creating tools for clinical leadership accountability. The interventions described are adoptable by most organized health systems. Reducing total opioid supply within communities should be given high priority by those with a mission to protect and improve public health.