St. John's Family Medicine Residency Program, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.
Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneap-olis, Minnesota.
J Opioid Manag. 2024 Jul-Aug;20(4):297-309. doi: 10.5055/jom.0869.
To describe the impact of a standardized opioid prescribing intervention when implemented in three family medicine (FM) residency training - clinics-environments that face operational challenges including regular resident turnover.
We performed a retrospective cohort study to compare patterns of long-term opioid prescribing between residency and nonresidency clinics.
This study took place within a large, academic, health system.
Three FM residency clinics were compared with three nonresidency FM clinics.
A standardized opioid prescribing process was developed and implemented within the FM residency clinics. Nonresidency clinics used an independent process and were not exposed to the intervention.
Descriptive comparisons were performed for treatment and control clinics' opioid prescribing from 2015 to 2018. The primary outcome was a patient's annual opioid exposure supplied from these select clinics. We also examine coprescribing with high-risk medications that potentiate the overdose risk of opioid prescriptions. Difference-in-difference modeling was used to control for clinic-level variation in practice.
Statistically significant decreases were observed in both residency and nonresidency clinics for the mean number of opioid prescriptions and the mean daily morphine milligram equivalent. These decreases were comparable between the residency and nonresidency clinics.
Residency clinics face unique challenges and require innovative solutions to keep up with best practices in opioid prescribing. Our residency clinics' implementation of a standardized intervention, including electronic health record integration, standardized processes, and metric management, suggests steps that may be valuable in achieving outcomes comparable to nonresidency clinics in large health systems.
描述在面临运营挑战（包括定期轮换住院医师）的三个家庭医学（FM）住院医师培训 - 诊所环境中实施标准化阿片类药物处方干预的影响。
我们进行了一项回顾性队列研究，比较了住院医师和非住院医师 FM 诊所之间长期阿片类药物处方的模式。
本研究在一个大型学术医疗系统中进行。
将三个 FM 住院医师诊所与三个非住院 FM 诊所进行比较。
在 FM 住院医师诊所内制定并实施了标准化的阿片类药物处方流程。非住院医师诊所使用独立的流程，并未接触到干预措施。
对 2015 年至 2018 年治疗和对照诊所的阿片类药物处方进行描述性比较。主要结果是这些选定诊所患者每年的阿片类药物暴露量。我们还检查了与潜在增加阿片类药物处方过量风险的高危药物的联合处方。差异差异模型用于控制诊所级实践差异。
住院医师和非住院医师诊所的平均阿片类药物处方数和平均每日吗啡毫克当量均明显下降。住院医师和非住院医师诊所之间的这些下降是可比的。
住院医师诊所面临独特的挑战，需要创新的解决方案来跟上阿片类药物处方的最佳实践。我们的住院医师诊所实施标准化干预措施，包括电子健康记录整合、标准化流程和指标管理，这表明在实现与大型医疗系统中非住院医师诊所相当的结果方面可能具有价值。
