scholarly journals Evaluation of an Educational Outreach Campaign (IMPACT) on Pain Management Delivered to General Practices in Walsall

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i48-i49
Author(s):  
S Visram ◽  
J Saini ◽  
R Mandvia
Keyword(s):  
Data Analysis ◽  
Pain Management ◽  
Cancer Pain ◽  
Educational Intervention ◽  
Opioid Analgesics ◽  
Educational Outreach ◽  
Opioid Prescribing ◽  
Prescribing Trends ◽  
The Impact

Abstract Introduction Opioid class drugs are a commonly prescribed form of analgesic widely used in the treatment of acute, cancer and chronic non-cancer pain. Up to 90% of individuals presenting to pain centres receive opioids, with doctors in the UK prescribing more and stronger opioids (1). Concern is increasing that patients with chronic pain are inappropriately being moved up the WHO ‘analgesic ladder’, originally developed for cancer pain, without considering alternatives to medications, (2). UK guidelines on chronic non-cancer pain management recommend weak opioids as a second-line treatment, when the first-line non-steroidal anti-inflammatory drugs / paracetamol) ineffective, and for short-term use only. A UK educational outreach programme by the name IMPACT (Improving Medicines and Polypharmacy Appropriateness Clinical Tool) was conducted on pain management. This research evaluated the IMPACT campaign, analysing the educational impact on the prescribing of morphine, tramadol and other high-cost opioids, in the Walsall CCG. Methods Standardised training material was delivered to 50 practices between December 2018 and June 2019 by IMPACT pharmacists. The training included a presentation on pain control, including dissemination of local and national guidelines, management of neuropathic, low back pain and sciatica as well as advice for prescribers on prescribing opioids in long-term pain, with the evidence-base. Prescribing trends in primary care were also covered in the training, and clinicians were provided with resources to use in their practice. Data analysis included reviewing prescribing data and evaluating the educational intervention using feedback from participants gathered via anonymous questionnaires administered at the end of the training. Prescribing data analysis was conducted by Keele University’s Medicines Management team via the ePACT 2 system covering October 2018 to September 2019 (two months before and three months after the intervention) were presented onto graphs to form comparisons in prescribing trends of the Midland CCG compared to England. Results Questionnaires completed at the end of sessions showed high levels of satisfaction, with feedback indicating that participants found the session well presented, successful at highlighting key messages, and effective in using evidence-based practice. 88% of participants agreed the IMPACT campaign increased their understanding of the management and assessment of pain, and prescribing of opioids and other resources available to prescribers. The majority (85%) wished to see this form of education being repeated regularly in the future for other therapeutic areas. Analysis of the prescribing data demonstrated that the total volume of opioid analgesics decreased by 1.7% post-intervention in the Midlands CCG in response to the pharmacist-led educational intervention. As supported by literature, the use of educational strategies, including material dissemination and reminders as well as group educational outreach was effective in engaging clinicians, as demonstrated by the reduction in opioid prescribing and high GP satisfaction in this campaign. Conclusion The IMPACT campaign was effective at disseminating pain-specific guidelines for opioid prescribing to clinicians, leading to a decrease in overall prescribing of opioid analgesics. Educational outreach as an approach is practical and a valuable means to improve prescribing by continuing medical education. References 1. Els, C., Jackson, T., Kunyk, D., Lappi, V., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F. and Straube, S. (2017). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. This provided the statistic of percentage receiving opioids that present to pain centres. 2. Heit, H. (2010). Tackling the Difficult Problem of Prescription Opioid Misuse. Annals of Internal Medicine, 152(11), p.747. Issues with prescriptions and inappropriate moving up the WHO ladder.

scholarly journals Analgesic prescribing habits and patterns of Canadian chief urology residents: A national survey

2020 ◽  
Vol 14 (6) ◽  
Author(s):  
Ali Dergham ◽  
Greg Hosier ◽  
Melanie Jaeger ◽  
J. Curtis Nickel ◽  
D. Robert Siemens ◽  
...  
Keyword(s):  
Pain Management ◽  
Response Rate ◽  
Formal Training ◽  
Knowledge Gaps ◽  
Opioid Prescribing ◽  
Review Course ◽  
Student’S T ◽  
The Impact ◽  
Student’S T Test

Introduction: Prior studies have identified significant knowledge gaps in acute and chronic pain management among graduating urology residents as of five years ago. Since then, there has been increasing awareness of the impact of excessive opioid prescribing on long-term narcotic use and development of adverse narcotic-related events. However, it is unclear whether the attitudes and experience of graduating urology residents have changed. We set out to evaluate the attitudes and experience of graduating urology residents in prescribing opioid/non-opioid analgesia for acute (AP), chronic non-cancer (CnC), and chronic cancer (CC) pain. Methods: Graduating urology residents were surveyed at a review course in 2018. The survey consisted of open-ended and close-ended five-point Likert scale questions. Descriptive statistics, Mann-Whitney U-test, and Student’s t-test were performed. Results: A total of 32 PGY5 urology residents completed our survey (92% response rate). The vast majority agreed that formal training in managing AP/CnC/CC to be valuable (91/78/81%). Most find their training in CnC/CC management to be inadequate and are unaware of any opioid prescribing guidelines; 66% never counsel patients on how to dispose of excess opioids. In general, 88% are comfortable prescribing opioids, whereas most are very uncomfortable prescribing cannabis or antidepressants (100%/78%). Residents reported the Acute Pain Service as the highest-rated resource for information, and dedicated textbooks the least. Conclusions: This survey demonstrated that experience in pain management remains variable among urology residents. Knowledge gaps remain, particularly in the management of chronic cancer/non-cancer pain.

scholarly journals Opioid Prescribing to Medicare Part D Enrollees, 2013–2017: Shifting Responsibility to Pain Management Providers

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1400-1407 ◽  
Author(s):  
Adam N Romman ◽  
Connie M Hsu ◽  
Lin-Na Chou ◽  
Yong-Fang Kuo ◽  
Rene Przkora ◽  
...  
Keyword(s):  
Pain Management ◽  
Medicare Part D ◽  
Medical Specialty ◽  
Medicare Part ◽  
Provider Type ◽  
Cross Sectional ◽  
Part D ◽  
Opioid Prescribing ◽  
Prescribing Trends ◽  
Level Analysis

Abstract Objective To examine opioid prescribing frequency and trends to Medicare Part D enrollees from 2013 to 2017 by medical specialty and provider type. Methods We conducted a retrospective, cross-sectional, specialty- and provider-level analysis of Medicare Part D prescriber data for opioid claims from 2013 to 2017. We analyzed opioid claims and prescribing trends for specialties accounting for ≥1% of all opioid claims. Results From 2013 to 2017, pain management providers increased Medicare Part D opioid claims by 27.3% to 1,140 mean claims per provider in 2017; physical medicine and rehabilitation providers increased opioid claims 16.9% to 511 mean claims per provider in 2017. Every other medical specialty decreased opioid claims over this period, with emergency medicine (–19.9%) and orthopedic surgery (–16.0%) dropping opioid claims more than any specialty. Physicians overall decreased opioid claims per provider by –5.2%. Meanwhile, opioid claims among both dentists (+5.6%) and nonphysician providers (+10.2%) increased during this period. Conclusions From 2013 to 2017, pain management and PMR increased opioid claims to Medicare Part D enrollees, whereas physicians in every other specialty decreased opioid prescribing. Dentists and nonphysician providers also increased opioid prescribing. Overall, opioid claims to Medicare Part D enrollees decreased and continue to drop at faster rates.

scholarly journals The Impact of the COVID-19 Pandemic on Antibiotic Prescribing Trends in Outpatient Care: A Nationwide, Quasi-Experimental Approach

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1040
Author(s):  
Tânia Magalhães Silva ◽  
Marta Estrela ◽  
Eva Rebelo Gomes ◽  
Maria Piñeiro-Lamas ◽  
Adolfo Figueiras ◽  
...  
Keyword(s):  
Public Health ◽  
Outpatient Care ◽  
Experimental Approach ◽  
National Level ◽  
Series Data ◽  
Antibiotic Prescribing ◽  
Prescribing Trends ◽  
Quasi Experimental ◽  
The Impact

Coronavirus disease 2019 (COVID-19) has spread globally and is currently having a damaging impact on nearly all countries in the world. The implementation of stringent measures to stop COVID-19 dissemination had an influence on healthcare services and associated procedures, possibly causing antibiotic consumption fluctuations. This paper aims to evaluate the immediate and long-term impact of the COVID-19 pandemic on antibiotic prescribing trends in outpatient care of the Portuguese public health sector, including in primary healthcare centers and hospitals, as well as on specific antibiotic groups known to be closely associated with increased resistance. Segmented regression analysis with interrupted time series data was used to analyze whether the COVID-19 pandemic had an impact in antibiotic prescribing tendencies at a national level. The outcomes from this quasi-experimental approach demonstrate that, at the beginning of the pandemic, a significant, immediate decrease in the overall antibiotic prescribing trends was noticed in the context of outpatient care in Portugal, followed by a statistically non-significant fall over the long term. The data also showed a significant reduction in the prescription of particular antibiotic classes (antibiotics from the Watch group, 3rd-generation cephalosporins, fluoroquinolones, and clarithromycin) upon COVID-19 emergence. These findings revealed an important disruption in antibiotics prescribing caused by the current public health emergency.

scholarly journals THE OPIOID EPIDEMIC IN LONG-TERM CARE: A STAFF PERSPECTIVE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S709-S709
Author(s):  
Rachael Hemmert ◽  
Gabriella E Dull ◽  
Linda S Edelman
Keyword(s):  
Pain Management ◽  
Long Term Care ◽  
Adverse Drug Events ◽  
Well Being ◽  
Educational Needs ◽  
Opioid Use ◽  
Term Care ◽  
Opioid Prescription ◽  
The Impact

Abstract Opioid-based analgesic therapy is a common treatment for moderate to severe pain among long term care (LTC) residents. It has been estimated that 60% of LTC residents have an opioid prescription. Of these, 14% use opioids as part of a long term pain management strategy. LTC residents are particularly vulnerable to opioid misuse, exhibiting higher rates of adverse drug events. However, addressing pain, polypharmacological needs and resident well-being in the LTC setting is challenging. More research and education regarding opioid use in LTC is needed. The Utah Geriatric Education Consortium conducted interprofessional focus groups with LTC partners to 1) determine educational needs of staff regarding opioid use, and 2) gather qualitative data about the pain management experiences of staff when working with residents and families. Staff identified the following training needs: pain manifestation and assessment; certified nurse assistant education on opioid use; non-pharmacological options for pain management. Review of staff’s perception of the intersection of opioids, family and staff in a LTC setting revealed that 1) family is concerned about opioid use; 2) conversely, staff may not see opioid use as a problem; and 3) non-pharmacological options for pain management are often costly and unavailable to those in LTC. Identifying educational needs of LTC staff will help guide the development of educational materials and provide baseline data for future assessments of the impact of opioid education on long-term care patient outcomes.

Academic Detailing to Reduce Sedative-Hypnotic Prescribing in Older Veterans

2019 ◽  
pp. 089719001987094 ◽  
Author(s):  
Addison P. Ragan ◽  
Garrett B. Aikens ◽  
Mark Bounthavong ◽  
Kevin Brittain ◽  
Anna Mirk
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Benzodiazepine Receptor ◽  
Educational Outreach ◽  
Potentially Inappropriate Medications ◽  
Veterans Health ◽  
Academic Detailing ◽  
Health Administration ◽  
Prescribing Trends ◽  
The Impact

Background: Sedative-hypnotics, including benzodiazepines (BZDs) and benzodiazepine receptor agonists (BZD-RA), are considered potentially inappropriate medications (PIMs) in older adults. Academic detailing, an educational outreach delivered by trained clinicians to other clinicians to encourage evidence-based care, can promote deprescribing of PIMs. Objective: To evaluate the impact of academic detailing on sedative-hypnotic prescribing to older veterans. Methods: A retrospective analysis was performed to evaluate the impact of academic detailing on BZD and BZD-RA prescribing to veterans aged 75 years and older. Prescribing trends for primary care and mental health prescribers in the Veterans Health Administration (VA) Southeast Network were calculated for the 18 months before and after an initial academic detailing session for each prescriber. Pre–post interrupted time series analyses (ITSAs) were conducted, and period prevalence was calculated as the number of prescriptions per 1000 older veterans. Results: A total of 155 prescribers were followed for 36 months. BZD prevalence declined by 23% (69.08-53.33 per 1000 population; P < .001) and by 15% for BZD-RA (18.07-15.38 per 1000 population; P < .001). New starts on BZD declined by 54% (2.36-1.09 per 1000 population; P < .001) and new starts on BZD-RA declined by 53% (1.02-0.48 per 1000 population; P < .001). Alternative medications for insomnia increased by 23% (39.98-49.27 per 1000 population; P < .001). Findings from the ITSA confirmed those of the pre–post analysis with sustained effects in the postintervention period. Conclusions: Academic detailing was associated with reduced sedative-hypnotic prescribing in the primary care and mental health setting.

scholarly journals All-cause mortality in patients with long-term opioid therapy compared with non-opioid analgesics for chronic non-cancer pain: a database study

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Winfried Häuser ◽  
Tino Schubert ◽  
Tobias Vogelmann ◽  
Christoph Maier ◽  
Mary-Ann Fitzcharles ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Opioid Analgesics ◽  
Opioid Therapy ◽  
Database Study ◽  
All Cause Mortality

scholarly journals Standardizing Opioid Prescribing Practices for Cancer-Related Pain Via a Novel Interactive Documentation Template at a Public Hospital

2019 ◽  
Vol 15 (11) ◽  
pp. e989-e996 ◽  
Author(s):  
Maliha Nusrat ◽  
Amanda Parkes ◽  
Ryan Kieser ◽  
Bei Hu ◽  
Dalia Farhat ◽  
...  
Keyword(s):  
At Risk ◽  
Pain Management ◽  
Cancer Pain ◽  
Systematic Approach ◽  
Opioid Misuse ◽  
Prescribing Practices ◽  
Cancer Pain Management ◽  
Opioid Prescribing ◽  
Community Oncology ◽  
Ensure Patient Safety

PURPOSE: Opioid misuse during cancer pain management places patients at risk for harm and physicians for legal liability. Identifying and monitoring patients who are at risk is challenging given the lack of validated clinical tools and evidence-based guidelines. In the current study, we aimed to standardize opioid prescribing practices at a community oncology clinic to help ensure patient safety and physician compliance with Texas state regulations. METHODS: We used the Plan-Do-Study-Act methodology. In the planning phase, current practices of assessing opioid efficacy, toxicity, and misuse were determined by surveying clinic physicians and reviewing patients’ charts. We developed a new standardized process that incorporated published literature, the Texas Administrative Code, and expert opinion. Two interactive documentation templates (SmartPhrases) were designed to implement the standardized process. The intervention was studied using repeat physician surveys and chart reviews, which prompted action for refinement and sustainability. RESULTS: At baseline, 9% of providers followed a systematic approach to prescribing opioids and 86% expressed an interest in process standardization. We noted high interprovider variability in the opioid risk stratification and refill process. At 2 months and 6 months postimplementation, provider satisfaction with the intervention was 83% and 75%, whereas compliance with SmartPhrase use was 70% and 54%, respectively. The frequency of state database check improved from 36% to 94% at 6 months. Improvement was also noted in assessment and documentation of baseline risk, chemical coping, and toxicity. CONCLUSION: We implemented a systematic approach for assessing opioid misuse, toxicity, and efficacy during cancer pain management at a community oncology clinic. The approach resulted in notable improvement in provider practices and documentation compliance.

Oxycodone Immediate Release for Cancer Pain Management in Turkey: Maximizing Value in Opioid Analgesics

2014 ◽  
Vol 3 (4) ◽  
pp. 207-217
Author(s):  
Robert Jr ◽  
◽  
Joseph Jr. ◽  
Gianpietro Zampogna ◽  
Fuat Demirelli ◽  
...  
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Opioid Analgesics ◽  
Immediate Release ◽  
Cancer Pain Management

State-level and system-level opioid prescribing policies: The impact on provider practices and overdose deaths, a systematic review

2016 ◽  
Vol 12 (2) ◽  
pp. 109 ◽  
Author(s):  
Francesca L. Beaudoin, MD, MS ◽  
Geetanjoli N. Banerjee, MPH ◽  
Michael J. Mello, MD, MPH
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
State Level ◽  
Opioid Analgesics ◽  
System Level ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Patient Level ◽  
The Impact

Objective: In response to persistent public health concerns regarding prescription opioids, many states and healthcare systems have implemented legislation and policies intended to regulate or guide opioid prescribing. The overall impact of these policies is still uncertain. The aim of this systematic review was to examine the existing evidence of provider-level and patient-level outcomes preimplementation and postimplementation of policies and legislation constructed to impact provider prescribing practices around opioid analgesics. Design: A systematic search of MEDLINE, EMBASE, the Web of Science, and the Cochrane Database of Systematic Reviews was conducted to identify studies evaluating the impact of opioid prescribing policies on provider-level and patient-level outcomes. The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results: Eleven studies were included in the review. A meta-analysis was not possible due to between-study heterogeneity. Six of the studies assessed state-level policies, and five were at the level of the healthcare system or hospital. Studies showed temporal associations between policy implementation and reductions in opioid prescribing, as well as opioid-related overdoses. Results were mixed regarding the impact of policies on misuse. The majority of the studies were judged to be of low quality based on the GRADE criteria.Conclusions: There is low to moderate quality evidence suggesting that the presence of opioid prescribing policy will reduce the amount and strength of opioid prescribed. The presence of these policies may impact the number of overdoses, but there is no clear evidence to suggest that it reduces opioid misuse.

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