scholarly journals State Medical Board Policy and Opioid Prescribing: A Controlled Interrupted Time Series

2020 ◽  
Author(s):  
Shabbar I. Ranapurwala ◽  
Christopher L. Ringwalt ◽  
Brian W. Pence ◽  
Sharon Schiro ◽  
Naoko Fulcher ◽  
...  
Keyword(s):  
Time Series ◽  
Interrupted Time Series ◽  
Opioid Prescribing ◽  
Medical Board ◽  
State Medical Board

scholarly journals Assessing the impact of a restrictive opioid prescribing law in West Virginia

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Cara L. Sedney ◽  
Maryam Khodaverdi ◽  
Robin Pollini ◽  
Patricia Dekeseredy ◽  
Nathan Wood ◽  
...  
Keyword(s):  
Time Series ◽  
West Virginia ◽  
Moving Average ◽  
Monitoring Program ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Opioid Prescribing ◽  
Small Change ◽  
The Impact ◽  
First Time

Abstract Background The Opioid Reduction Act (SB 273) took effect in West Virginia in June 2018. This legislation limited ongoing chronic opioid prescriptions to 30 days’ supply, and first-time opioid prescriptions to 7 days’ supply for surgeons and 3 days’ for emergency rooms and dentists. The purpose of this study was to determine the effect of this legislation on reducing opioid prescriptions in West Virginia, with the goal of informing future similar policy efforts. Methods Data were requested from the state Prescription Drug Monitoring Program (PDMP) including overall number of opioid prescriptions, number of first-time opioid prescriptions, average daily morphine milligram equivalents (MME) and prescription duration (expressed as “days’ supply”) given to adults during the 64 week time periods before and after legislation enactment. Statistical analysis was done utilizing an autoregressive integrated moving average (ARIMA) interrupted time series analysis to assess impact of both legislation announcement and enactment while controlling secular trends and considering autocorrelation trends. Benzodiazepine prescriptions were utilized as a control. Results Our analysis demonstrates a significant decrease in overall state opioid prescribing as well as a small change in average daily MME associated with the date of the legislation’s enactment when considering serial correlation in the time series and accounting for pre-intervention trends. There was no such association found with benzodiazepine prescriptions. Conclusion Results of the current study suggest that SB 273 was associated with an average 22.1% decrease of overall opioid prescriptions and a small change in average daily MME relative to the date of legislative implementation in West Virginia. There was, however, no association of the legislation on first-time opioid prescriptions or days’ supply of opioid medication, and all variables were trending downward prior to implementation of SB 273. The control demonstrated no relationship to the law.

scholarly journals 1086Methodological challenges using routine aggregated data in a primary care implementation trial on opioid prescribing

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Tracey Farragher ◽  
Sarah Alderson ◽  
Paul Carder ◽  
Tom Willis ◽  
Robbie Foy
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Routine Data ◽  
Interrupted Time Series ◽  
Data Sources ◽  
Research Database ◽  
Feedback Intervention ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
The Impact

Abstract Focus of Presentation There is international concern over rising trends in opioid prescribing, largely attributed to prescribing for chronic non-cancer pain. We conducted a controlled interrupted time series study on anonymised, aggregated practice data to evaluate the effect of the Campaign to Reduce Opioid Prescribing (CROP) in reducing the number of patients taking opioid medication in West Yorkshire UK practices targeted by the feedback intervention, compared to practices outside of West Yorkshire. We will discuss the methodological challenges addressed in the collection and analysis of these data, and the implications for using routine data in trials. Findings Primary care data sources for feedback interventions include large-scale databases (General Practice Research Database), high-level nationally gathered databases (OpenPrescribing.com) or data extracted directly from electronic health records (EHR). We will discuss the implications of the different sources of data and compare the results from each, in understanding the impact of the feedback intervention of reducing opioid prescribing over time. The consequences of the heterogeneity of the data sources on the interrupted time series analysis undertaken will also be discussed and solutions outlined. Conclusions/Implications Routine data are heterogeneous, with different purposes, structures and collection methods, which have considerable implications on their use, analysis and interpretation. Researchers need to understand that the utility of routine data sources have implications (both practically and methodologically) in conducting pragmatic trials, which should be considered when planning and conducting future studies using routine data.

scholarly journals Assessing The Impact of A Restrictive Opioid Prescribing Law in West Virginia

2020 ◽  
Author(s):  
Cara L. Sedney ◽  
Maryam Khodaverdi ◽  
Robin Pollini ◽  
Patricia Dekeseredy ◽  
Nathan Wood ◽  
...  
Keyword(s):  
Time Series ◽  
West Virginia ◽  
Moving Average ◽  
Monitoring Program ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Emergency Rooms ◽  
Opioid Prescribing ◽  
The Impact ◽  
First Time

Abstract Background: The Opioid Reduction Act (SB 273) took effect in West Virginia in June 2018. This legislation limited ongoing chronic opioid prescriptions to 30 days’ supply, and first-time opioid prescriptions to 7 days’ supply for surgeons and 3 days’ for emergency rooms and dentists. The purpose of this study was to determine the effect of this legislation on reducing opioid prescriptions in West Virginia, with the goal of informing future similar policy efforts. Methods: Data were requested from the state Prescription Drug Monitoring Program (PDMP) including overall number of opioid prescriptions, number of first-time opioid prescriptions, average daily morphine milligram equivalents (MME) and prescription duration (expressed as “day’s supply”) given to adults during the 64 week time periods before and after legislation enactment. Statistical analysis was done utilizing an autoregressive integrated moving average (ARIMA) interrupted time series analysis to assess impact of both legislation announcement and enactment while controlling secular trends and considering autocorrelation trends. Benzodiazepine prescriptions were utilized as a control.Results: Our analysis demonstrates a statistically significant decrease in overall state opioid prescribing as well as average daily MME associated with the date of the legislation’s enactment when considering serial correlation in the time series and accounting for pre-intervention trends. There was no such association found with benzodiazepine prescriptions.Conclusion: Results of the current study suggest that SB 273 was associated with an average 22.1% decrease of overall opioid prescriptions and a small overall decrease of average daily MME relative to the date of legislative implementation in West Virginia. There was, however, no association of the legislation on first-time opioid prescriptions or days’ supply of opioid medication, and all variables were trending downward prior to implementation of SB 273. The control demonstrated no relationship to the law.

scholarly journals Assessing the impact of SIGN 136 on opioid prescribing rates in Scotland: An interrupted time series analysis

2021 ◽  
Author(s):  
Harry L. Hébert ◽  
Daniel R. Morales ◽  
Nicola Torrance ◽  
Blair H. Smith ◽  
Lesley A. Colvin
Keyword(s):  
Chronic Pain ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Opioid Prescribing ◽  
Prescribing Trends ◽  
The Impact

AbstractBackgroundOpioids are used to treat patients with chronic pain, but their long-term use is associated with harms. In December 2013, SIGN 136 was published, providing a comprehensive evidence-based guideline for the assessment and management of chronic pain in ScotlandAimsThis study aimed to examine the impact of SIGN 136 on opioid prescribing trends and costs across the whole of Scotland.MethodsOpioid prescribing data and average cost per item were obtained from Public Health Scotland. An interrupted time series analysis examined the effects of SIGN 136 publication on the number of items prescribed per 1,000 population per quarter for 29 opioids (or opioid-containing combinations) from 2005 to 2019 inclusive. Exploratory analysis was conducted in NHS Tayside and NHS Fife combined and then up-scaled to all 14 NHS Scotland health boards. A similar approach was also used to assess the effect of SIGN 136 on estimated gross ingredient costs per quarter.ResultsAt six years post-intervention there was a relative reduction in opioid prescribing of 18.8% (95% CI: 16.0-21.7) across Scotland. There was also a relative reduction of 22.8% (95%: 14.9-30.1) in gross ingredient cost nationally. Opioid prescribing increased significantly pre-intervention across all 14 NHS Scotland health boards (2.19 items per 1000 population per quarter), followed by a non-significant change in level and a significant negative change in trend post-intervention (−2.69 items per 1000 population per quarter). Similar findings were observed locally in NHS Tayside and NHS Fife.ConclusionsThe publication of SIGN 136 coincided with a statistically significant reduction in opioid prescribing rates in Scotland and suggests that changes in clinical policy are having a positive effect on prescribing practices in primary care. These prescribing trends appear to be in contrast to the UK as a whole.

scholarly journals The effects of an evidence- and theory-informed feedback intervention on opioid prescribing for non-cancer pain in primary care: A controlled interrupted time series analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003796
Author(s):  
Sarah L. Alderson ◽  
Tracey M. Farragher ◽  
Thomas A. Willis ◽  
Paul Carder ◽  
Stella Johnson ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
High Risk ◽  
High Risk Patient ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Opioid Prescribing ◽  
Patient Groups ◽  
Comparative Feedback ◽  
Strong Opioids

Background The rise in opioid prescribing in primary care represents a significant international public health challenge, associated with increased psychosocial problems, hospitalisations, and mortality. We evaluated the effects of a comparative feedback intervention with persuasive messaging and action planning on opioid prescribing in primary care. Methods and findings A quasi-experimental controlled interrupted time series analysis used anonymised, aggregated practice data from electronic health records and prescribing data from publicly available sources. The study included 316 intervention and 130 control primary care practices in the Yorkshire and Humber region, UK, serving 2.2 million and 1 million residents, respectively. We observed the number of adult patients prescribed opioid medication by practice between July 2013 and December 2017. We excluded adults with coded cancer or drug dependency. The intervention, the Campaign to Reduce Opioid Prescribing (CROP), entailed bimonthly, comparative, and practice-individualised feedback reports to practices, with persuasive messaging and suggested actions over 1 year. Outcomes comprised the number of adults per 1,000 adults per month prescribed any opioid (main outcome), prescribed strong opioids, prescribed opioids in high-risk groups, prescribed other analgesics, and referred to musculoskeletal services. The number of adults prescribed any opioid rose pre-intervention in both intervention and control practices, by 0.18 (95% CI 0.11, 0.25) and 0.36 (95% CI 0.27, 0.46) per 1,000 adults per month, respectively. During the intervention period, prescribing per 1,000 adults fell in intervention practices (change −0.11; 95% CI −0.30, −0.08) and continued rising in control practices (change 0.54; 95% CI 0.29, 0.78), with a difference of −0.65 per 1,000 patients (95% CI −0.96, −0.34), corresponding to 15,000 fewer patients prescribed opioids. These trends continued post-intervention, although at slower rates. Prescribing of strong opioids, total opioid prescriptions, and prescribing in high-risk patient groups also generally fell. Prescribing of other analgesics fell whilst musculoskeletal referrals did not rise. Effects were attenuated after feedback ceased. Study limitations include being limited to 1 region in the UK, possible coding errors in routine data, being unable to fully account for concurrent interventions, and uncertainties over how general practices actually used the feedback reports and whether reductions in prescribing were always clinically appropriate. Conclusions Repeated comparative feedback offers a promising and relatively efficient population-level approach to reduce opioid prescribing in primary care, including prescribing of strong opioids and prescribing in high-risk patient groups. Such feedback may also prompt clinicians to reconsider prescribing other medicines associated with chronic pain, without causing a rise in referrals to musculoskeletal clinics. Feedback may need to be sustained for maximum effect.

State Medical Board Disciplinary Hearings as Tools for Teaching Professionalism in Medical Education

2011 ◽  
Vol 97 (3) ◽  
pp. 8-12
Author(s):  
Onelia G. Lage ◽  
Sydney F. Pomenti ◽  
Edwin Hayes ◽  
Kristen Barrie ◽  
Nancy Baker
Keyword(s):  
Medical Students ◽  
Ethics Education ◽  
Faculty Members ◽  
Specific Method ◽  
Pilot Studies ◽  
Medical Board ◽  
Medical Institutions ◽  
State Medical Boards ◽  
State Medical Board ◽  
The Impact

ABSTRACT This article proposes a partnership of state medical boards with medical schools to supplement professionalism and ethics education for medical students, residents, physicians and faculty members of medical institutions. The importance of professionalism has been recognized by several studies, but a specific method of teaching and developing professionalism has yet to emerge. Studies suggest that there is an association between a lack of professionalism in medical school and future disciplinary actions by medical boards. However, there has been little collaboration between these institutions in addressing unprofessional behaviors. One collaborative concept that holds promise, however, is the idea of inviting medical students to attend physician disciplinary hearings. Students and physicians alike report that watching a hearing can significantly impact attitudes about professionalism as a part of medical practice. While formal research is scarce, the positive response of individual students who experience disciplinary hearings firsthand suggests that further pilot studies may be useful. Presented in this paper are the perspectives of three individuals — a medical student, a faculty member and a medical board chair — who discuss the impact and potential of attending disciplinary hearings in developing professionalism and ethics. Also included is a review of the current literature.

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