Montague Magda, Hopson Charlotte, Layton Claire, Fishe Jennifer, Norse Ashley, Webb L Kendall, Duran-Gehring Petra, Bertrand Andrew, Brailsford Jennifer, Munson Taylor, Wang Rui, Menze Nolan, Perl Katelyn, Hendry Phyllis, Sheikh Sophia
Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA.
Center for Data Solutions, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
BMC Emerg Med. 2025 Jan 8;25(1):5. doi: 10.1186/s12873-024-01168-7.
The ongoing opioid epidemic in the United States has reinforced the need to provide multimodal and non-opioid pain management interventions. The PAMI-ED ALT program employed a multifaceted approach in the Emergency Department (ED) developing electronic health record (EHR) pain management order panels and discharge panels, as well as educating patients, clinicians, and ED staff on opioid alternatives, including non-pharmacologic interventions. The primary objective of this analysis was to compare changes in opioid and non-opioid analgesic administrations and prescribing in ED patients with select pain conditions (renal colic, headache, low back, and non-low back musculoskeletal pain) before and after implementation of PAMI ED-ALT. Secondary outcomes included characterizing changes in 30-day ED all-cause recidivism and hospital all-cause admissions within these pain populations.
Demographics, opioid and opioid alternative utilization, hospital admission, 30-day ED returns and change in pain intensity score were collected from January 2019-March 2020 (pre-program implementation) and January 2021-March 2023 (post-program implementation) for both the ED aggregate and program target pain populations.
Pain management order panel utilization increased throughout the post-implementation period. When comparing pre to post program data, there was a reduction in opioid administrations and prescriptions for most of the target pain conditions, as well as within the ED aggregate population. Opioid alternative administrations and prescriptions increased for all pain conditions except renal colic. Hospital admissions decreased significantly amongst those with low back pain and headache/migraine and 30-day ED returns significantly declined in those with musculoskeletal pain.
Our findings demonstrate an opioid-alternatives program implemented within a safety-net hospital system serving a predominantly socially disadvantaged patient population can lead to changes in ED pain management and potentially reduce 30-day ED recidivism and hospitalizations.
美国持续的阿片类药物泛滥强化了提供多模式和非阿片类疼痛管理干预措施的必要性。PAMI-ED ALT项目在急诊科采用了多方面的方法，开发电子健康记录（EHR）疼痛管理医嘱面板和出院面板，并就阿片类药物替代品（包括非药物干预措施）对患者、临床医生和急诊科工作人员进行教育。本分析的主要目的是比较PAMI ED-ALT实施前后，患有特定疼痛病症（肾绞痛、头痛、腰痛和非腰痛肌肉骨骼疼痛）的急诊科患者中阿片类和非阿片类镇痛药的使用及处方变化。次要结果包括描述这些疼痛人群中30天急诊科全因再入院率和医院全因住院率的变化。
收集了2019年1月至2020年3月（项目实施前）以及2021年1月至2023年3月（项目实施后）急诊科总体人群和项目目标疼痛人群的人口统计学数据、阿片类和阿片类药物替代品的使用情况、住院情况、30天急诊科复诊情况以及疼痛强度评分变化。
在实施后的整个期间，疼痛管理医嘱面板的使用率有所提高。比较项目实施前后的数据时，大多数目标疼痛病症以及急诊科总体人群中的阿片类药物使用和处方量均有所减少。除肾绞痛外，所有疼痛病症的阿片类药物替代品使用和处方量均有所增加。腰痛和头痛/偏头痛患者的住院率显著下降，肌肉骨骼疼痛患者的30天急诊科复诊率显著下降。
我们的研究结果表明，在主要服务于社会弱势群体的安全网医院系统内实施的阿片类药物替代项目可导致急诊科疼痛管理的改变，并有可能降低30天急诊科再入院率和住院率。
