Flipping the script: The effects of opioid prescription monitoring on specialty‐specific provider behavior

2021 ◽  
Author(s):  
Alice M. Ellyson ◽  
Jevay Grooms ◽  
Alberto Ortega
Keyword(s):  
Opioid Prescription ◽  
Provider Behavior ◽  
Prescription Monitoring ◽  
Specific Provider

scholarly journals A Systematic Review of Interventions and Programs Targeting Appropriate Prescribing of Opioids

2019 ◽  
Vol 3 (22;3) ◽  
pp. 229-240 ◽  
Author(s):  
Yola Moride
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Evaluation Studies ◽  
The United States ◽  
Opioid Prescription ◽  
Overdose Death ◽  
Opioid Prescribing ◽  
Gray Literature ◽  
Prescription Monitoring ◽  
Monitoring Programs

Background: Canada and the United States have the highest levels of prescription opioid consumption in the world. In an attempt to curb the opioid epidemic, a variety of interventions have been implemented. Thus far, evidence regarding their effectiveness has not been consolidated. Objectives: The objectives of this study were to: 1) identify interventions that target opioid prescribing; 2) assess and compare the effectiveness of interventions on opioid prescription and related harms; 3) determine the methodological quality of evaluation studies. Study Design: The study involved a systematic review of the literature including bibliographical databases and gray literature sources. Setting: Systematic review including bibliographical databases and gray literature sources. Methods: We searched MEDLINE, Embase, and LILACS databases from January 1, 2005 to September 23, 2016 for any intervention that targeted the prescription of opioids. We also examined websites of relevant organizations and scanned bibliographies of included articles and reviews for additional references. The target population was that of all health care providers (HCPs) or users of opioids with no restriction on indication. Endpoints were those related to process (implementation), outcomes (effectiveness), or impact. Sources were screened independently by 2 reviewers using pre-defined eligibility criteria. Synthesis of findings was qualitative; no pooling of results was conducted. Results: Literature search yielded 12,278 unique sources. Of these, 142 were retained. During full-text review, 75 were further excluded. Searches of the gray literature and bibliographies yielded 49 additional sources. Thus, a total of 95 distinct interventions were identified. Over half consisted of prescription monitoring programs (PMPs) and mainly targeted HCPs. Evaluation studies addressed mainly opioid prescription rate (30.6%), opioid use (19.4%), or doctor shopping or diversion (9.7%). Fewer studies considered overdose death (9.7%), abuse (9.7%), misuse (4.2%), or diversion (5.6%). Study designs consisted of cross-sectional surveys (23.3%), pre-post intervention (26.7%), or time series without a comparison group (13.3%), which limit the robustness of the evidence. Although PMPs and policies have been associated with a reduction in opioid prescription, their impact on appropriateness of use according to clinical guidelines and restriction of access to patients in need is inconsistent. Continuing medical education (CME) and pain management programs were found effective in improving chronic pain management, but studies were conducted in specific settings. The impact of interventions on abuse and overdose-death is conflicting. Limitations: Due to the very large number of publications and programs found, it was difficult to compare interventions owing to the heterogeneity of the programs and to the methodologies of evaluation studies. No assessment of publication bias was done in the review. Conclusions: Evidence of effectiveness of interventions targeting the prescription of opioids is scarce in the literature. Although PMPs have been associated with a reduction in the overall prescription rates of Schedule II opioids, their impact on the appropriateness of use taking into consideration benefits, misuse, legal and illegal use remains elusive. Our review suggests that existing interventions have not addressed all determinants of inappropriate opioid prescribing and usage. A well-described theoretical framework would be the backdrop against which targeted interventions or policies may be developed. Key words: Opioid, prescription, abuse, misuse, diversion, interventions, prescription monitoring programs

scholarly journals Patient Satisfaction With Providers: Do Patient Surveys Give Enough Information to Help Providers Improve Specific Behaviors

2019 ◽  
Vol 6 ◽  
pp. 233339281988528
Author(s):  
Frederick North ◽  
Sidna M. Tulledge-Scheitel
Keyword(s):  
Patient Satisfaction ◽  
Patient Experience ◽  
Factor Model ◽  
Patient Survey ◽  
Significant Information ◽  
Provider Behavior ◽  
Specific Provider ◽  
Experience Survey ◽  
Highly Correlated ◽  
Survey Responses

Background: Patient satisfaction surveys ask patients specific questions about provider behavior such as whether they were satisfied with the provider’s instructions about medications or time spent with the patient. It’s unclear how responses to these surveys can help providers focus on specific behaviors to improve. Methods: In a primary care setting, we analyzed Press Ganey patient experience survey responses. We examined the 10 questions dealing with satisfaction specific to the care provider experience. We used the “Top Box” counts (counts of most favorable responses) and Top Box% (percentage of most favorable response) for categorical and continuous measures of patient satisfaction. Results: For 12 consecutive months, 652 providers of 1014 accumulated at least 300 total responses from patients for the 10 provider-related questions. Only 8 of the 652 providers had significant differences ( P < .05) in Top Box% for the 10 questions. Correlation of responses between the questions were between 0.86 and 0.96. Analysis of variance showed that 87% of the total variation in the Top Box% of the 10 questions was between providers and only 13% within providers. Factor analysis found no independent factors within the 10 questions (ie, a one factor model was sufficient; P < .0001). Conclusion: Patient survey questions appear to ask about specific provider behaviors that contribute to patient experience. However, the responses to 10 different questions are highly correlated and may not give providers or management enough statistically significant information to focus patient experience improvement efforts for individual providers.

Usefulness of prescription monitoring programs for surveillance-analysis of Schedule II opioid prescription data in Massachusetts, 1996-2006

2010 ◽  
Vol 19 (2) ◽  
pp. 115-123 ◽  
Author(s):  
Nathaniel Katz ◽  
Lee Panas ◽  
MeeLee Kim ◽  
Adele D. Audet ◽  
Arnold Bilansky ◽  
...  
Keyword(s):  
Prescription Data ◽  
Opioid Prescription ◽  
Prescription Monitoring ◽  
Monitoring Programs ◽  
Surveillance Analysis

Laser Papillotomy for Chronic Flank Pain: A Reassessment of Efficacy in the Era of Automated Opioid Prescription Monitoring

2019 ◽  
Vol 6 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Karen L. Stern ◽  
Manoj Monga
Keyword(s):  
Flank Pain ◽  
Opioid Prescription ◽  
Prescription Monitoring

scholarly journals Variability in opioid prescription monitoring and evidence of aberrant medication taking behaviors in urban safety-net clinics

Pain ◽  
2015 ◽  
Vol 156 (2) ◽  
pp. 335-340 ◽  
Author(s):  
Allison Lange ◽  
Karen E. Lasser ◽  
Ziming Xuan ◽  
Laila Khalid ◽  
Donna Beers ◽  
...  
Keyword(s):  
Safety Net ◽  
Opioid Prescription ◽  
Prescription Monitoring ◽  
Safety Net Clinics ◽  
Urban Safety

scholarly journals How Reliable Is a Statewide Prescription Monitoring Program for Identifying Post-Cesarean Opioid Use?

2020 ◽  
Vol 10 (01) ◽  
pp. e101-e105
Author(s):  
Ashish Premkumar ◽  
Sedona E. Speedy ◽  
Emily S. Miller
Keyword(s):  
Logistic Regression ◽  
Cesarean Section ◽  
Tertiary Care ◽  
Monitoring Program ◽  
Prescription Opioid ◽  
Multivariable Logistic Regression Analysis ◽  
Care Hospital ◽  
Opioid Prescription ◽  
Prescription Monitoring ◽  
Multivariable Logistic Regression

Abstract Objective This study was aimed to estimate the percentage of women taking opioids post-cesarean who could be detected in a state prescription monitoring program (PMP) and characteristics of those not able to be detected. Study Design This observational cohort study included all women with an Illinois address who delivered via cesarean section and used opioids within 24 hours prior to discharge at a tertiary care hospital between August 21, 2017 and March 1, 2018. The Illinois PMP was queried for presence of an opioid prescription filled within the first 3 months postpartum. Sociodemographic and clinical factors associated with an undetectable PMP record were evaluated in bivariable and multivariable logistic regression analyses. Results A total of 517 women underwent a cesarean delivery during the study period, of whom 344 (66.5%) met inclusion criteria. Of these women, 169 (49%) did not have a detectable PMP record of filling any outpatient postpartum prescription opioid. On bivariable and multivariable logistic regression analysis, year of delivery (2018 vs. 2017) was significantly associated with a higher incidence of detectable postpartum prescription opioid record in the PMP with increasing relative risk of detectable records in the second year of analyses (n = 110/244 [45%] in 2017 vs. n = 59/100 [59%] in 2018, adjusted risk ratio [aRR] = 1.32, 95% confidence interval [CI]: 1.06–1.64, p = 0.013). No other sociodemographic or clinical characteristics was significantly associated. Conclusion Nearly half of women who underwent a cesarean section and who were administered opioids 24 hours prior to discharge did not have a detectable postpartum opioid prescription in the PMP. While identification of prescription filling improved with time, many of women were not detectable in the PMP system. These data call into question the accuracy of PMPs in identifying prescription opioid filling patterns in the postpartum setting.

Prescription Monitoring Program Utilization Survey

2020 ◽  
Author(s):  
Jeff Reist ◽  
Joseph Frazier ◽  
Alecia Rottingham ◽  
Mackenzie Welsh ◽  
Brahmendra Reddy Viyyuri ◽  
...  
Keyword(s):  
Monitoring Program ◽  
Prescription Monitoring

Impact of Preoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients

2020 ◽  
Author(s):  
Ali Aneizi ◽  
Patrick M. J. Sajak ◽  
Aymen Alqazzaz ◽  
Tristan Weir ◽  
Cameran I. Burt ◽  
...  
Keyword(s):  
Physical Function ◽  
Patient Reported Outcomes ◽  
Knee Surgery ◽  
The Body ◽  
Pain Interference ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Social Satisfaction ◽  
Patient Reported ◽  
Met Expectations

AbstractThe objectives of this study are to assess perioperative opioid use in patients undergoing knee surgery and to examine the relationship between preoperative opioid use and 2-year postoperative patient-reported outcomes (PROs). We hypothesized that preoperative opioid use and, more specifically, higher quantities of preoperative opioid use would be associated with worse PROs in knee surgery patients. We studied 192 patients undergoing knee surgery at a single urban institution. Patients completed multiple PRO measures preoperatively and 2-year postoperatively, including six patient-reported outcomes measurement information system (PROMIS) domains; the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale (NPS) scores for the operative knee and the rest of the body, Marx's knee activity rating scale, Tegner's activity scale, International Physical Activity Questionnaire, as well as measures of met expectations, overall improvement, and overall satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Eighty patients (41.7%) filled an opioid prescription preoperatively, and refill TMEs were significantly higher in this subpopulation. Opioid use was associated with unemployment, government insurance, smoking, depression, history of prior surgery, higher body mass index, greater comorbidities, and lower treatment expectations. Preoperative opioid use was associated with significantly worse 2-year scores on most PROs, including PROMIS physical function, pain interference, fatigue, social satisfaction, IKDC, NPS for the knee and rest of the body, and Marx's and Tegner's scales. There was a significant dose-dependent association between greater preoperative TMEs and worse scores for PROMIS physical function, pain interference, fatigue, social satisfaction, NPS body, and Marx's and Tegner's scales. Multivariable analysis confirmed that any preoperative opioid use, but not quantity of TMEs, was an independent predictor of worse 2-year scores for function, activity, and knee pain. Preoperative opioid use and TMEs were neither independent predictors of met expectations, satisfaction, patient-perceived improvement, nor improvement on any PROs. Our findings demonstrate that preoperative opioid use is associated with clinically relevant worse patient-reported knee function and pain after knee surgery.

PASIFIKA FUTURES WHĀNAU ORA: F’INE – Nurturing the Future for Pasifika LGBTQI

2019 ◽  
Vol 21 (4) ◽  
Author(s):  
Saneta Manoa ◽  
Phylesha Brown-Acton ◽  
Tatryanna Utanga ◽  
Seini Jensen
Keyword(s):  
Mental Health ◽  
New Zealand ◽  
Poor Mental Health ◽  
Depression And Anxiety ◽  
The Future ◽  
Specific Provider

F’INE Aotearoa, through Pasifika Futures Whānau Ora programme, is supporting Pacific Lesbian, Gay, Bisexual, Transgender, Queer and Intersex (LGBTQI) individuals and their families to transform their lives and achieve their aspirations.  The LGBTQI community in New Zealand experience significant disadvantage across a range of areas affecting wellbeing, including higher rates of poor mental health, depression and anxiety 1,2,3. For Pacific LGBTQI, the disadvantages are compounded further.  F’INE, an LGBTQI specific provider in New Zealand, is working to change this.

Sign in / Sign up

Export Citation Format

Share Document