靶向质量改进教育对阿片类药物处方的影响。

Effect of a targeted quality improvement education on opioid prescribing.

机构信息

University of Rochester Medical Center, Rochester, New York, USA.

SUNY Upstate Medical University, Syracuse, New York, USA.

出版信息

BMJ Open Qual. 2023 Aug;12(3). doi: 10.1136/bmjoq-2022-001915.

DOI:10.1136/bmjoq-2022-001915

PMID:37580088

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10432641/

Abstract

BACKGROUND

The opioid epidemic is a serious social, economic and public health problem. This study was designed to evaluate the effectiveness of individual institutional opioid prescriber training on prescriber adherence to the Centers for Disease Control and Prevention (CDC's) guidelines for responsible opioid prescribing practices to treat acute pain.

METHODS

Opioid prescribing data were collected from an academic medical centre and its associated outpatient clinics. A baseline for opioid prescribing practices was collected for 2 years and 2 months prior to the planned intervention. Departments responsible for 5% or more of the total institutional opioid prescriptions were chosen to study in detail. A number of opioid prescriptions per department per day and their compliance with the maximum daily dose (MDD) recommendations put out by the CDC were determined.

INTERVENTION

The hospital administration implemented a mandatory opioid prescriber training as part of their standard annual provider education for all medical staff, who were all required to attest having read it and pass a quiz by 30 September 2019, which was chosen as the end date for the pre-intervention data. Data were analysed preintervention and postintervention to assess the effect of this intervention on opioid prescribing.

RESULTS

Overall opioid prescribing rates decreased by 18.3% and there were significant decreases in opioid prescribing rate in five out of the seven departments/divisions. Overall, there was a statistically significant decrease in the compliance with MDD before (71.3%) and after (67.3%) the intervention (4%, 95% CI 3.13% to 4.87% difference, p<0.001). Additionally, there were statistically significant increases in compliance with CDC guidelines in three departments/divisions. However, there was a statistically significant decrease in compliance with CDC guidelines after intervention in two departments.

CONCLUSIONS

The results of this study were largely encouraging for the effectiveness of this institutional mandatory prescriber training.

摘要

背景

阿片类药物泛滥是一个严重的社会、经济和公共卫生问题。本研究旨在评估针对个体医疗机构阿片类药物开方者的培训对遵循疾病控制与预防中心（CDC）关于负责任的阿片类药物处方实践指南以治疗急性疼痛的效果。

方法

从一家学术医疗中心及其附属门诊收集阿片类药物处方数据。在计划干预之前的 2 年零 2 个月内收集了阿片类药物处方实践的基线数据。选择负责机构 5%以上总阿片类药物处方的部门进行详细研究。确定每个部门每天开出的阿片类药物处方数量及其与 CDC 发布的最大日剂量（MDD）建议的符合程度。

干预

医院管理部门实施了强制性的阿片类药物开方者培训，作为其对所有医务人员的标准年度提供者教育的一部分，所有医务人员都必须在 2019 年 9 月 30 日之前阅读并通过测验，这一天被选为干预前数据的截止日期。在干预前后分析数据，以评估该干预对阿片类药物处方的影响。

结果

总体上，阿片类药物处方率下降了 18.3%，7 个部门/科室中有 5 个部门的阿片类药物处方率显著下降。总体而言，干预前（71.3%）和干预后（67.3%）MDD 符合率有统计学显著下降（4%，95%置信区间 3.13%至 4.87%差异，p<0.001）。此外，有 3 个部门/科室的 CDC 指南符合率有统计学显著增加。然而，有 2 个部门的 CDC 指南符合率在干预后出现统计学显著下降。