Department of Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland. ORCID: https://orcid.org/0000-0002-5591-8033.
Department of Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland.
J Opioid Manag. 2021 Mar-Apr;17(2):169-179. doi: 10.5055/jom.2021.0626.
To date, the majority of studies have focused on the adverse effect of opioid overutilization on outcomes, risk factors for overutilization and dependence, and the development of procedure-specific guidelines. We present the results of a multiphased approach to reducing opioid prescribing.
A retrospective pre-post study of opioid prescriptions across 386,393 patient encounters was conducted. The preintervention cohort included patient encounters from November 2016 to March 2017, and the post-intervention cohort included encounters from April 2017 to October 2019.
Single-institution orthopedic practice.
PATIENTS, PARTICIPANTS: 386,393 patient encounters.
Multiple prescribing reduction interventions were implemented from April 2017 to July 2018.
Average morphine milligram equivalent (MME) per patient encounter.
Implementation of the interventions resulted in an average reduction of 15.2 MME per encounter (54.5 percent) compared to the preimplementation cohort (pre: avg. MME = 27.9, SD 113.6; post: avg. MME = 12.7, SD 66.1; p < 0.001). The number of pills per opioid prescription was reduced by 13.4 (29.5 percent) (pre: avg. pill count = 45.5, S.D. 25.1; post: avg. pill count = 32.1, SD 21.1; p < 0.001), and the percent of patients receiving opioids was reduced from 8.3 percent to 5.8 percent (p < 0.001). Prescribing compliance was evaluated for 7,664 surgical encounters, with 98.2 percent of prescriptions meeting stated guidelines; 5.5 percent of these encounters required second prescriptions.
The use of a multiphase approach effectively reduced the opioid prescribing patterns of a large orthopedic practice and was successful across subspecialties. This approach provides a template that other institutions may use to reduce opioid overprescribing in orthopedic practices.
迄今为止，大多数研究都集中在阿片类药物过度使用对结果的不良影响、过度使用和依赖的危险因素，以及特定程序指南的制定上。我们介绍了一种多阶段方法来减少阿片类药物的处方。
对 386393 例患者就诊的阿片类药物处方进行回顾性前后研究。干预前队列包括 2016 年 11 月至 2017 年 3 月的患者就诊情况，干预后队列包括 2017 年 4 月至 2019 年 10 月的就诊情况。
单机构骨科门诊。
患者、参与者：386393 例患者就诊。
从 2017 年 4 月至 2018 年 7 月实施了多种减少处方的干预措施。
每位患者就诊的平均吗啡毫克当量（MME）。
与实施前队列相比，干预措施的实施使每位患者就诊的平均 MME 减少了 15.2 MME（54.5%）（实施前：平均 MME=27.9，SD113.6；实施后：平均 MME=12.7，SD66.1；p<0.001）。每张阿片类药物处方的药丸数量减少了 13.4 颗（29.5%）（实施前：平均药丸数=45.5，SD25.1；实施后：平均药丸数=32.1，SD21.1；p<0.001），接受阿片类药物的患者比例从 8.3%降至 5.8%（p<0.001）。对 7664 例手术就诊进行了处方依从性评估，98.2%的处方符合规定；其中 5.5%的处方需要第二次处方。
多阶段方法的使用有效地减少了大型骨科门诊的阿片类药物处方模式，并在各个亚专业领域取得了成功。这种方法为其他机构提供了一个模板，以减少骨科门诊中阿片类药物的过度处方。
