Slovis Benjamin Heritier, Riggio Jeffrey M, Girondo Melanie, Martino Cara, Babula Bracken, Roke Lindsey M, Kairys John C
Office of Clinical Informatics, Thomas Jefferson University, Philadelphia, PA, United States.
Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States.
J Med Internet Res. 2021 Apr 14;23(4):e24360. doi: 10.2196/24360.
The United States is in an opioid epidemic. Passive decision support in the electronic health record (EHR) through opioid prescription presets may aid in curbing opioid dependence.
The objective of this study is to determine whether modification of opioid prescribing presets in the EHR could change prescribing patterns for an entire hospital system.
We performed a quasi-experimental retrospective pre-post analysis of a 24-month period before and after modifications to our EHR's opioid prescription presets to match Centers for Disease Control and Prevention guidelines. We included all opioid prescriptions prescribed at our institution for nonchronic pain. Our modifications to the EHR include (1) making duration of treatment for an opioid prescription mandatory, (2) adding a quick button for 3 days' duration while removing others, and (3) setting the default quantity of all oral opioid formulations to 10 tablets. We examined the quantity in tablets, duration in days, and proportion of prescriptions greater than 90 morphine milligram equivalents/day for our hospital system, and compared these values before and after our intervention for effect.
There were 78,246 prescriptions included in our study written on 30,975 unique patients. There was a significant reduction for all opioid prescriptions pre versus post in (1) the overall median quantity of tablets dispensed (54 [IQR 40-120] vs 42 [IQR 18-90]; P<.001), (2) median duration of treatment (10.5 days [IQR 5.0-30] vs 7.5 days [IQR 3.0-30]; P<.001), and (3) proportion of prescriptions greater than 90 morphine milligram equivalents/day (27.46% [10,704/38,976; 95% CI 27.02%-27.91%] vs 22.86% [8979/39,270; 95% CI 22.45%-23.28%]; P<.001).
Modifications of opioid prescribing presets in the EHR can improve prescribing practice patterns. Reducing duration and quantity of opioid prescriptions could reduce the risk of dependence and overdose.
美国正处于阿片类药物流行之中。通过电子健康记录（EHR）中的阿片类药物处方预设提供的被动决策支持可能有助于遏制阿片类药物依赖。
本研究的目的是确定修改EHR中的阿片类药物处方预设是否会改变整个医院系统的处方模式。
我们对EHR的阿片类药物处方预设进行修改以符合疾病控制与预防中心指南前后的24个月期间进行了一项准实验性回顾性前后分析。我们纳入了在我们机构开具的所有用于非慢性疼痛的阿片类药物处方。我们对EHR的修改包括：（1）使阿片类药物处方的治疗时长成为必填项；（2）添加一个为期3天的快速按钮，同时移除其他按钮；（3）将所有口服阿片类药物制剂的默认数量设置为10片。我们检查了我们医院系统的片剂数量、天数时长以及每日超过90毫克吗啡当量的处方比例，并比较了干预前后这些值以评估效果。
我们的研究纳入了为30975名不同患者开具的78246份处方。所有阿片类药物处方在干预前后相比，（1）所配发片剂的总体中位数数量有显著减少（54片[四分位间距40 - 120]对42片[四分位间距18 - 90]；P <.001），（2）治疗的中位数时长（10.5天[四分位间距5.0 - 30]对7.5天[四分位间距3.0 - 30]；P <.001），以及（3）每日超过90毫克吗啡当量的处方比例（27.46%[10704/38976；95%置信区间27.02% - 27.91%]对22.86%[8979/39270；95%置信区间22.45% - 23.28%]；P <.001）。
修改EHR中的阿片类药物处方预设可以改善处方实践模式。减少阿片类药物处方的时长和数量可以降低依赖和过量用药的风险。
