Department of Emergency Medicine, Northwestern University, Chicago, IL.
Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL.
Acad Emerg Med. 2019 Dec;26(12):1311-1325. doi: 10.1111/acem.13860. Epub 2019 Nov 19.
Despite increased focus on opioid prescribing, little is known about the influence of prescription opioid medication information given to patients in the emergency department (ED). The study objective was to evaluate the effect of an Electronic Medication Complete Communication (EMC ) Opioid Strategy on patients' safe use of opioids and knowledge about opioids.
This was a three-arm prospective, randomized controlled pragmatic trial with randomization occurring at the physician level. Consecutive discharged patients at an urban academic ED (>88,000 visits) with new hydrocodone-acetaminophen prescriptions received one of three care pathways: 1) usual care, 2) EMC intervention, or 3) EMC + short message service (SMS) text messaging. The ED EMC intervention triggered two patient-facing educational tools (MedSheet, literacy-appropriate prescription wording [Take-Wait-Stop]) and three provider-facing reminders to counsel (directed to ED physician, dispensing pharmacist, follow-up physician). Patients in the EMC + SMS arm additionally received one text message/day for 1 week. Follow-up at 1 to 2 weeks assessed "demonstrated safe use" (primary outcome). Secondary outcomes including patient knowledge and actual safe use (via medication diaries) were assessed 2 to 4 days and 1 month following enrollment.
Among the 652 enrolled, 343 completed follow-up (57% women; mean ± SD age = 42 ± 14.0 years). Demonstrated safe opioid use occurred more often in the EMC group (adjusted odds ratio [aOR] = 2.46, 95% confidence interval [CI] = 1.19 to 5.06), but not the EMC + SMS group (aOR = 1.87, 95% CI = 0.90 to 3.90) compared with usual care. Neither intervention arm improved medication safe use as measured by medication diary data. Medication knowledge, measured by a 10-point composite knowledge score, was greater in the EMC + SMS group (β = 0.57, 95% CI = 0.09 to 1.06) than usual care.
The study found that the EMC tools improved demonstrated safe dosing, but these benefits did not translate into actual use based on medication dairies. The text-messaging intervention did result in improved patient knowledge.
尽管人们越来越关注阿片类药物的处方问题，但对于在急诊科（ED）向患者提供处方类阿片类药物信息的影响知之甚少。本研究的目的是评估电子药物完整沟通（EMC）阿片类药物策略对患者安全使用阿片类药物和了解阿片类药物的影响。
这是一项三臂前瞻性随机对照实用临床试验，在医师层面进行随机分组。在一个城市学术 ED（>88000 次就诊）接受新氢可酮-对乙酰氨基酚处方的连续出院患者接受以下三种治疗途径之一：1）常规护理，2）EMC 干预，或 3）EMC+短信服务（SMS）文本消息。ED EMC 干预会触发两个面向患者的教育工具（MedSheet，适合阅读水平的处方措辞[服用-等待-停止]）和三个面向提供者的咨询提醒（针对 ED 医师、配药药剂师、随访医师）。EMC+SMS 组的患者另外每天接收一条短信，持续 1 周。在 1 至 2 周时进行随访，评估“表现出安全使用”（主要结局）。次要结局包括患者知识和实际安全使用（通过药物日记），在入组后 2 至 4 天和 1 个月进行评估。
在 652 名入组患者中，有 343 名完成了随访（57%为女性；平均±SD 年龄=42±14.0 岁）。与常规护理相比，EMC 组表现出安全使用阿片类药物的情况更为常见（调整后的优势比[OR] = 2.46，95%置信区间[CI] = 1.19 至 5.06），而 EMC+SMS 组则不然（调整后的 OR = 1.87，95% CI = 0.90 至 3.90）。干预组均未改善药物日记数据显示的药物安全使用情况。以 10 分综合知识评分衡量的药物知识在 EMC+SMS 组更高（β=0.57，95%CI=0.09 至 1.06），高于常规护理组。
该研究发现，EMC 工具提高了安全剂量的表现，但这些益处并未转化为基于药物日记的实际使用。短信干预确实导致了患者知识的提高。
