一项阿片类药物电子处方政策对常见上肢手术后医生处方模式的影响。
The Effect of an Electronic Prescribing Policy for Opioids on Physician Prescribing Patterns Following Common Upper Extremity Procedures.
作者信息
Shoji Monica M, Bernstein David N, Merchan Nelson, McFarlane Kelly, Harper Carl M, Rozental Tamara D
机构信息
Harvard Combined Orthopaedic Surgery Residency Program, Massachusetts General Hospital, Boston, MA.
Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Beth Israel Deaconess Medical Center, Boston, MA.
出版信息
J Hand Surg Glob Online. 2022 Jan 13;4(2):71-77. doi: 10.1016/j.jhsg.2021.12.001. eCollection 2022 Mar.
PURPOSE
We evaluated physician prescribing patterns before and after the implementation of a state-mandated opioid electronic prescribing (ePrescribing) program after 4 common outpatient hand surgeries. Specifically, we aimed to answer the following: (1) is there a change in the number of opioids prescribed after the institution of ePrescribing for carpal tunnel release (CTR), ganglion excision, distal radius fracture (DRF) open reduction internal fixation (ORIF), and carpometacarpal (CMC) arthroplasty and (2) what factors are associated with an increased number of tablets or total morphine milligram equivalents (MMEs) prescribed.
METHODS
We retrospectively reviewed patients who underwent CTR, ganglion excision, DRF ORIF, or CMC arthroplasty and analyzed the number of tablets and MMEs prescribed before and after the policy implementation, as well as which factors were associated with an increased total number of opioid tablets and MMEs prescribed.
RESULTS
A total of 428 patients were included. After policy implementation, there was a significant decrease in MMEs prescribed for ganglion excision (68 [SD, 45] vs 50 [SD, 60], = .03) and CMC arthroplasty (283 [SD, 147] vs 217 [SD, 92], < .01). There was also a significant decrease in the total number of tablets prescribed for ganglion excision (11 [SD, 5.7] vs 6.8 [SD, 8.0], < .01), CMC arthroplasty (36 [SD, 13] vs 29 [SD, 12], < .01), and DRF ORIF (31 [SD, 8.6] vs 28 [SD, 8.5], = .04). The number of patients receiving any opioid prescription also significantly decreased following CTR (30% vs 51%, = .03) and ganglion excision (11% vs 53%, < .01).
CONCLUSIONS
The initiation of state-mandated ePrescribing was associated with a decreased number of opioids-both MMEs and tablets-prescribed after surgery by hand surgeons for a variety of common procedures. Furthermore, a greater percentage of patients received no opioid prescriptions after ePrescribing. These findings support the value of ePrescribing as a potential tool to further decrease excess opioid prescriptions.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
目的
我们评估了在一项州强制推行的阿片类药物电子处方（ePrescribing）计划实施前后，4种常见门诊手部手术后医生的处方模式。具体而言，我们旨在回答以下问题：（1）在实施腕管松解术（CTR）、腱鞘囊肿切除术、桡骨远端骨折（DRF）切开复位内固定术（ORIF）和腕掌关节（CMC）置换术后，电子处方制度实施后阿片类药物的处方数量是否有变化；（2）哪些因素与处方片剂数量增加或总吗啡毫克当量（MME）增加相关。
方法
我们回顾性分析了接受CTR、腱鞘囊肿切除术、DRF ORIF或CMC置换术的患者，并分析了政策实施前后的处方片剂数量和MME，以及哪些因素与阿片类药物片剂和MME的总处方量增加相关。
结果
共纳入428例患者。政策实施后，腱鞘囊肿切除术（68[标准差，45]对50[标准差，60]，P = 0.03）和CMC置换术（283[标准差，147]对217[标准差，92]，P < 0.01）的MME显著减少。腱鞘囊肿切除术（11[标准差，5.7]对6.8[标准差，8.0]，P < 0.01）、CMC置换术（36[标准差，13]对29[标准差，12]，P < 0.01）和DRF ORIF（31[标准差，8.6]对28[标准差，8.5]，P = 0.04）的总处方片剂数量也显著减少。接受任何阿片类药物处方的患者数量在CTR（30%对51%，P = 0.03）和腱鞘囊肿切除术（11%对53%，P < 0.01）后也显著减少。
结论
州强制推行电子处方与手部外科医生在多种常见手术后开具的阿片类药物数量（MME和片剂）减少相关。此外，电子处方实施后，更大比例的患者未接受阿片类药物处方。这些发现支持电子处方作为进一步减少过量阿片类药物处方的潜在工具的价值。
研究类型/证据水平：治疗性III级。
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