Postoperative Opioid Prescribing Practices and Evidence-Based Guidelines in Bariatric Surgery

2019 ◽  
Vol 29 (7) ◽  
pp. 2030-2036 ◽  
Author(s):  
Danielle T. Friedman ◽  
Saber Ghiassi ◽  
Matthew O. Hubbard ◽  
Andrew J. Duffy
Keyword(s):  
Bariatric Surgery ◽  
Evidence Based ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Evidence Based Guidelines

scholarly journals P113: Examining emergency physicians’ self-reported opioid prescribing practices for the treatment of acute pain: A Newfoundland perspective

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S105-S106
Author(s):  
P. Doran ◽  
G. Sheppard ◽  
B. Metcalfe
Keyword(s):  
Emergency Department ◽  
Acute Pain ◽  
Oral Morphine ◽  
Prescribing Patterns ◽  
Evidence Based ◽  
Emergency Physicians ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Ensure Patient Safety ◽  
Evidence Based Guidelines

Introduction: Canadians are the second largest consumers of prescription opioids per capita in the world. Emergency physicians tend to prescribe stronger and larger quantities of opioids, while family physicians write the most opioid prescriptions overall. These practices have been shown to precipitate future dependence, toxicity and the need for hospitalization. Despite this emerging evidence, there is a paucity of research on emergency physicians’ opioid prescribing practices in Canada. The objectives of this study were to describe our local emergency physicians’ opioid prescribing patterns both in the emergency department and upon discharge, and to explore factors that impact their prescribing decisions. Methods: Emergency physicians from two urban, adult emergency departments in St. John's, Newfoundland were anonymously surveyed using a web-based survey tool. All 42 physicians were invited to participate via email during the six-week study period and reminders were sent at weeks two and four. Results: A total of 21 participants responded to the survey. Over half of respondents (57.14%) reported that they “often” prescribe opioids for the treatment of acute pain in the emergency department, and an equal number of respondents reported doing so “sometimes” at discharge. Eighty-five percent of respondents reported most commonly prescribing intravenous morphine for acute pain in the emergency department, and over thirty-five percent reported most commonly prescribing oral morphine upon discharge. Patient age and risk of misuse were the most frequently cited factors that influenced respondents’ prescribing decisions. Only 4 of the 22 respondents reported using evidence-based guidelines to tailor their opioid prescribing practices, while an overwhelming majority (80.95%) believe there is a need for evidence-based opioid prescribing guidelines for the treatment of acute pain. Sixty percent of respondents completed additional training in safe opioid prescribing, yet less than half of respondents (42.86%) felt they could help to mitigate the opioid crisis by prescribing fewer opioids in the emergency department. Conclusion: Emergency physicians frequently prescribe opioids for the treatment of acute pain and new evidence suggests that this practice can lead to significant morbidity. While further research is needed to better understand emergency physicians’ opioid prescribing practices, our findings support the need for evidence-based guidelines for the treatment of acute pain to ensure patient safety.

Reduction in Schedule II opioid prescribing by primary care providers, orthopedic and general surgeons, and pain management specialists following the implementation of a State House Bill and an Institutional Controlled Substance Task Force

2021 ◽  
Vol 17 (2) ◽  
pp. 155-167
Author(s):  
Lisa B. E. Shields, MD ◽  
Timothy A. Johnson, BS ◽  
Michael W. Daniels, MS ◽  
Alisha Bell, MSN, RN, CPN ◽  
Diane M. Siemens, PharmD ◽  
...  
Keyword(s):  
Primary Care ◽  
Pain Management ◽  
Primary Care Providers ◽  
The United States ◽  
Prescription Opioid ◽  
Evidence Based ◽  
Care Providers ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
General Surgeons

Objective: Prescription opioid misuse represents a social and economic challenge in the United States. We evaluated Schedule II opioid prescribing practices by primary care providers (PCPs), orthopedic and general surgeons, and pain management specialists.Design: Prospective evaluation of prescribing practices of PCPs, orthopedic and general surgeons, and pain management specialists over 5 years (October 1, 2014-September 30, 2019) in an outpatient setting.Methods: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards at our institution. Results: There were significantly more PCPs, orthopedic and general surgeons, and pain management specialists with a significantly increased number who prescribed Schedule II opioids, whereas there was a simultaneous significant decline in the average number of Schedule II opioid prescriptions per provider, Schedule II opioid pills prescribed per provider, and Schedule II opioid pills prescribed per patient by providers. The average number of Schedule II opioid prescriptions with a quantity 90 and Opana/Oxycontin prescriptions per PCP, orthopedic surgeon, and pain management specialist significantly decreased. The total morphine milligram equivalent (MME)/day of Schedule II opioids ordered by PCPs, orthopedic and general surgeons, and pain management specialists significantly declined. The ages of the providers remained consistent throughout the study. Conclusions: This study reports the implementation of federal and state regulations and institutional evidence-based guidelines into primary care and medical specialty practices to reduce the number of Schedule II opioids prescribed. Further research is warranted to determine alternative therapies to Schedule II opioids that may alleviate a patient’s pain without initiating or exacerbating a potentially lethal opioid addiction.

Creating an Opioid Recommendation Card for Trainees: Methods, Use, and Impact

2020 ◽  
pp. 000313482094062
Author(s):  
Mollie R. Freedman-Weiss ◽  
Alexander S. Chiu ◽  
Erin M. White ◽  
Peter S. Yoo
Keyword(s):  
Postoperative Analgesia ◽  
Opioid Analgesic ◽  
Junior Resident ◽  
Evidence Based ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Surgical Residents ◽  
Surgical Trainees ◽  
Wide Variability ◽  
The Impact

Background In academic hospitals, surgical residents write most of the postoperative prescriptions; yet, few residents are trained on postoperative analgesia. This leads to wide variability in practices and often excess opioid prescribing. We sought to create an opioid guideline pocket card for surgical residents to access when prescribing opioids postoperatively and to evaluate the impact of this initiative. Methods A comprehensive literature review was conducted to generate evidence-based procedure-specific opioid recommendations; additional recommendations were formulated via consensus opinion from surgical divisions at an academic institution. A pocket-sized guideline card was developed to include these procedure-specific recommendations as well as opioid guidelines for discharges after inpatient stays, non-opioid analgesic recommendations, access to opioid safety and disposal instructions for patients discharge, an equianalgesic dosing chart, and instructions for naloxone use. The card was distributed to all General Surgery house staff at a university-affiliated hospital in the spring of 2018. Following the distribution, trainees were surveyed on their use of the card. Descriptive statistics were used to analyze the survey. Results Of 85 trainees, 62 (72.9%) responded to the survey in full; 58% use the card regularly. Of the 27 junior resident respondents, 70.4% use the card at least monthly including 48.1% who use the card daily-to-weekly. Overall, 81.6% of residents changed their opioid-prescribing practices because of this initiative and 89.8% believe the card should continue to be distributed and used. Discussion An evidence-based guideline card for postoperative analgesia is highly valued and utilized by surgical trainees, especially those most junior in their training.

Influencing antiemetic prescribing practices and funding changes through evidence-based guidelines.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 31-31
Author(s):  
Kathy Vu ◽  
Michael Wan ◽  
Aliya Pardhan ◽  
Erin Redwood ◽  
Andrea Crespo ◽  
...  
Keyword(s):  
Public Funding ◽  
Drug Benefit ◽  
Evidence Based ◽  
Drug Formulary ◽  
Prescribing Practices ◽  
Receptor Antagonists ◽  
Line Therapy ◽  
Evidence Based Guidelines ◽  
The Impact ◽  
Made In

31 Background: In 2013 Cancer Care Ontario released updated antiemetic recommendations supporting the use of aprepitant-based combinations as 1st line therapy for highly emetogenic and 2nd line therapy for moderately emetogenic chemotherapy and discouraging the prolonged use of 5-HT3 antagonists. In 2014 changes were made in the Ontario drug formulary to align public funding to those recommendations. The impact of the changes in guidance and public funding on prescribing practices are now being analyzed. Methods: Using the Ontario Drug Benefit (ODB) database, data was extracted to analyze the prescribing practices of aprepitant, granisetron and ondansetron for chemotherapy-induced emesis between the pre-funding period (November 2013 to September 2014) and post-funding period (October 2014 to July 2015). Results: Prior to funding changes, an average of 197 prescriptions/month of aprepitant were billed to the ODB program totaling $22,422. After funding, an average of 1,165 prescriptions/month of aprepitant were billed totaling $132,145. This represented a 490% increase in utilization. The combined 5-HT3 receptor antagonists prescriptions/month billed during the respective time periods were 5,592 ($405,604) and 5,536 ($402,628). This represented a 1% decrease in utilization. Conclusions: There was a significant increase in aprepitant utilization and total expenditure to the ODB program indicating strong uptake of the triple-drug recommendation for highly emetogenic regimens. However, there was minimal change in prescribing practices related to the 5-HT3 receptor antagonists, indicating a reluctance to decrease utilization. Further work is necessary to discourage the prolonged use of 5-HT3 receptor antagonists.

Qualitative insights into the opioid prescribing practices of Australian GP

2019 ◽  
Vol 37 (3) ◽  
pp. 412-417
Author(s):  
Pallavi Prathivadi ◽  
Chris Barton ◽  
Danielle Mazza
Keyword(s):  
Chronic Pain ◽  
Research Network ◽  
World Health ◽  
Evidence Based ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Attitudes And Practices ◽  
Factors Influencing ◽  
Age Related

Abstract Background Over the last three decades, Australian opioid-prescribing rates and related morbidity and mortality have dramatically increased. Opioids are frequently prescribed by general practitioners (GPs) to manage chronic non-cancer pain, despite evidence-based recommendations from the Centre for Disease Control, National Institute for Health and Care Excellence and World Health Organization widely cautioning their use. Little is known about the factors influencing the opioid prescribing decisions of Australian GPs, especially when not evidence based. Objective To explore the opioid prescribing knowledge, attitudes and practices of Australian GPs. Methods Semi-structured interviews with 20 GPs recruited from the Monash University practice-based research network in metropolitan, southeastern Melbourne. Thematic analysis was used to identify emergent themes. Data were managed using QSR NVivo. Ethics approval was granted by Monash University. Results Three key themes emerged. GP attitudes towards opioid use for chronic pain varied by age of patient and goals for therapy. Use of opioids for elderly patients was positively perceived. GPs were reluctant to use opioids in younger patients due to fears of addiction and difficulty weaning. GPs felt obliged to prescribe opioids recommended by specialists, even if they believed the opioids were unsafe. Conclusion This study identified and described the patient-centred nature of GP opioid prescribing decisions. Patient age and perceived age-related opioid harm were important factors influencing prescribing decisions. Future work should inform interventions that value GP autonomy while still encouraging a collaborative inter-speciality approach to managing chronic pain patients with opioids.

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