Department of Pharmacy, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.
Mid-Atlantic Permanente Medical Group, Rockville, MD, USA.
Perm J. 2023 Dec 15;27(4):64-71. doi: 10.7812/TPP/23.063. Epub 2023 Sep 25.
Clinical decision support tools support prescribers and pharmacists as they select and verify appropriate opioid regimens in efforts to combat the high variability in opioid prescribing. This study seeks to examine the impact of alerts within the electronic medical record and pharmacy system on day supply of initial opioid prescribing and dispensing.
This retrospective study compared a 6-month pre- and postimplementation of clinical decision support tool alerts at an integrated health care system. Data were analyzed to assess changes in the day supply of an opioid at the point of initial prescribing and dispensing based on alerts.
The best practice alert in the electronic medical record was associated with a 27% change (p = 0.007) in prescribing by the physician, which resulted in a reduction of average day supply from 12.09 to 6.58 days. The alert in the pharmacy system was associated with a 41.3% change (p < 0.001) in dispensing, which resulted in a reduction of average day supply from 13.46 to 6.96 days.
To promote judicious opioid prescribing, the best practice alert in the electronic medical record led to a statistically significant change in prescribing. To support appropriate dispensing, the alert in the pharmacy system led to a statistically significant change in dispensing.
Implementation of two clinical decision support tools that mirrored Centers for Disease Control and Prevention recommendations of prescribing less than a 7-day supply when initiating opioids resulted in a decrease in day supply of the opioid prescription for patients identified as opioid-naïve at the point of prescribing and dispensing.
临床决策支持工具可帮助医生和药剂师选择和验证合适的阿片类药物治疗方案，以努力解决阿片类药物处方的高度变异性问题。本研究旨在考察电子病历和药房系统中的警报对初始阿片类药物处方和配药的日供应量的影响。
本回顾性研究比较了在一个综合医疗保健系统中临床决策支持工具警报实施前后的 6 个月数据。对数据进行分析，以评估根据警报在初始开方和配药时阿片类药物的日供应量的变化。
电子病历中的最佳实践警报与医生处方的 27%变化相关（p = 0.007），这导致平均日供应量从 12.09 天减少到 6.58 天。药房系统中的警报与配药的 41.3%变化相关（p < 0.001），这导致平均日供应量从 13.46 天减少到 6.96 天。
为了促进合理的阿片类药物处方，电子病历中的最佳实践警报导致处方方面发生了统计学上的显著变化。为了支持适当的配药，药房系统中的警报导致配药方面发生了统计学上的显著变化。
实施了两种临床决策支持工具，这些工具反映了疾病预防控制中心的建议，即当开始使用阿片类药物时，处方量少于 7 天，这导致了处方和配药时被认定为阿片类药物无经验的患者的阿片类药物处方日供应量减少。
