Understanding Opioid Prescribing Practices of Resident Physicians

2021 ◽  
pp. 000313482110604
Author(s):  
Julia M. Coughlin ◽  
Samantha L. Terranella ◽  
Ethan M. Ritz ◽  
Thomas Q. Xu ◽  
John F. Tierney ◽  
...  
Keyword(s):  
Best Practice ◽  
Monitoring Program ◽  
Resident Training ◽  
Prescribing Practices ◽  
Exact Test ◽  
Opioid Prescribing ◽  
Resident Physicians ◽  
Order Sets ◽  
Patient’S History ◽  
Safe Opioid Prescribing

Background To compare opioid prescribing practices of resident physicians across a variety of surgical and nonsurgical specialties; to identify factors which influence prescribing practices; and to examine resident utilization of best practice supplemental resources. Methods An anonymous survey which assessed prescribing practices was completed by residents from one of several different subspecialties, including internal medicine, obstetrics and gynecology, general surgery, neurosurgery, orthopedic surgery, and urology. Fisher’s exact test assessed differences in prescribing practices between specialties. Results Only 35% of residents reported receiving formal training in safe opioid prescribing. Overall, the most frequently reported influences on prescribing practices were the use of standardized order sets for specific procedures, attending preference, and patient’s history of prescribed opioids. Resident physicians significantly underutilize best practice supplemental resources, such as counseling patients on pain expectations prior to prescribing opioid medication; contacting established pain specialists; screening patients for opioid abuse; referring to the Prescription Monitoring Program; and counseling patients on safe disposal of unused pills ( P < .001). Discussion The incorporation of comprehensive prescribing education into resident training and the utilization of standardized order sets can promote safe opioid prescribing.

Why we still prescribe so many opioids: A qualitative study on barriers and facilitators to prescribing guideline implementation

2021 ◽  
Vol 17 (2) ◽  
pp. 115-124
Author(s):  
Kathryn W. Zavaleta, MHSA ◽  
Lindsey M. Philpot, PhD, MPH ◽  
Julie L. Cunningham, PharmD, RPh ◽  
Halena M. Gazelka, MD ◽  
Holly L. Geyer, MD ◽  
...  
Keyword(s):  
Best Practice ◽  
Guideline Implementation ◽  
Healthcare Setting ◽  
Medical Specialty ◽  
Critical Systems ◽  
Healthcare Organizations ◽  
Opioid Prescribing ◽  
Daunting Challenge ◽  
Additional Education ◽  
Safe Opioid Prescribing

Introduction: Opioid prescribing occurs within almost every healthcare setting. Implementation of safe, effective opioid stewardship programs represents a critical but daunting challenge for medical leaders. This study sought to understand the barriers and aids to the routine use of clinical guidelines for opioid prescribing among healthcare professionals and to identify areas in need of additional education for prescribing providers, pharmacists, and nurses.Methods: Data collection and analysis in 2018-2019 employed a team of two trained facilitators who conducted 20 focus groups using a structured facilitation guide to explore operational, interpersonal, and patient care-related barriers to best practice adherence. Each professional group was interviewed separately, with similar care settings assigned together. Invitation to participate was based on a sampling methodology representing emergency, medical specialty, primary care, and surgical practice settings.Results: Key concerns among all groups reflected the inadequacy of available tools for staff to appropriately assess and treat patients’ pain. Tools and technology to support safe opioid prescribing were also cited as a barrier by all three professional groups. All groups noted that prescribers tend to rely upon default settings within the electronic medical record when issuing prescriptions. Both pharmacists and prescribers cited time and scheduling as a barrier to adherence.Conclusions: In spite of significant regulatory and public policy efforts to address the opioid crisis, healthcare organizations face significant challenges to improve adherence to best practice prescribing guidelines. These findings highlight several facilitators for change which could boost opioid stewardship initiatives to focus on critical systems’ factors for improvement.

scholarly journals At-a-glance - Concurrent monitoring of opioid prescribing practices and opioid-related deaths: the context in Nova Scotia, Canada

2018 ◽  
Vol 38 (9) ◽  
pp. 334-338 ◽  
Author(s):  
Emily Schleihauf ◽  
Kirstin Crabtree ◽  
Carolyn Dohoo ◽  
Sarah Fleming ◽  
Heather McPeake ◽  
...  
Keyword(s):  
Nova Scotia ◽  
Public Health Surveillance ◽  
Monitoring Program ◽  
Population Level ◽  
Medical Examiner ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Prescription Monitoring ◽  
Dispensing Data

Timely public health surveillance is required to understand trends in opioid use and harms. Here, opioid dispensing data from the Nova Scotia Prescription Monitoring Program are presented alongside fatality data from the Nova Scotia Medical Examiner Service. Concurrent monitoring of trends in these data sources is essential to detect population-level effects (whether intended or unintended) of interventions related to opioid prescribing.

Attributes, Attitudes, and Practices of Clinicians Concerned with Opioid Prescribing

Pain Medicine ◽  
2018 ◽  
Vol 20 (10) ◽  
pp. 1934-1941 ◽  
Author(s):  
Zayd Razouki ◽  
Bushra A Khokhar ◽  
Lindsey M Philpot ◽  
Jon O Ebbert
Keyword(s):  
Monitoring Program ◽  
Program Review ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Attitudes And Practices ◽  
Urine Drug ◽  
Noncancer Pain

Abstract Background Many clinicians who prescribe opioids for chronic noncancer pain (CNCP) express concerns about opioid misuse, addiction, and physiological dependence. We evaluated the association between the degree of clinician concerns (highly vs less concerned), clinician attributes, other attitudes and beliefs, and opioid prescribing practices. Methods A web-based survey of clinicians at a multispecialty medical practice. Results Compared with less concerned clinicians, clinicians highly concerned with opioid misuse, addiction, and physiological dependence were more confident prescribing opioids (risk ratio [RR] = 1.34, 95% confidence interval [CI] = 1.08–1.67) but were more reluctant to do so (RR = 1.13, 95% CI = 1.03–1.25). They were more likely to report screening patients for substance use disorder (RR = 1.18, 95% CI = 1.01–1.37) and to discontinue prescribing opioids to a patient due to aberrant opioid use behaviors (RR = 1.30, 95% CI = 1.13–1.50). They were also less likely to prescribe benzodiazepines and opioids concurrently (RR = 0.40, 95% CI = 0.25–0.65). Highly concerned clinicians were more likely to work in clinics which engage in “best practices” for opioid prescribing requiring urine drug screening (RR = 4.65, 95% CI = 2.51–8.61), prescription monitoring program review (RR = 2.90, 95% CI = 1.84–4.56), controlled substance agreements (RR = 4.88, 95% CI = 2.64–9.03), and other practices. Controlling for clinician concern, prescribing practices were also associated with clinician confidence, reluctance, and satisfaction. Conclusions Highly concerned clinicians are more confident but more reluctant to prescribe opioids. Controlling for clinician concern, confidence in care and reluctance to prescribe opioids were associated with more conservative prescribing practices.

scholarly journals Prescription Drug Monitoring Program Use: National Dental PBRN Results

2018 ◽  
Vol 4 (2) ◽  
pp. 178-186 ◽  
Author(s):  
J.L. McCauley ◽  
G.H. Gilbert ◽  
D.L. Cochran ◽  
V.V. Gordan ◽  
R.S. Leite ◽  
...  
Keyword(s):  
Pain Management ◽  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Practice Characteristics ◽  
Prescription Drug Monitoring Program ◽  
Barriers To Use ◽  
Outreach And Education

Introduction: The American Dental Association recommends that dentists use a prescription drug monitoring program (PDMP) prior to prescribing an opioid for acute pain management. Objective: The objective of this study was to examine dentists’ experiences using their state PDMP, as well as the impact that state-mandated registration policies, mandated use policies, and practice characteristics had on the frequency with which dentists used their PDMP. Methods: We conducted a web-based cross-sectional survey among practicing dentist members of the National Dental Practice-Based Research Network ( n = 805). The survey assessed prescribing practices for pain management and implementation of risk mitigation strategies, including PDMP use. Survey data were linked with network Enrollment Questionnaire data to include practitioner demographics and practice characteristics. Results: Nearly half of respondents ( n = 375, 46.6%) reported having never accessed a PDMP, with the most common reasons for nonaccess being lack of awareness ( n = 214, 57.1%) and lack of knowledge regarding registration and use ( n = 94, 25.1%). The majority of PDMP users reported the program to be very helpful (58.1%) or somewhat helpful (31.6%). Dentists reported that PDMP use most often did not change their intended prescribing behavior (40.2%), led them not to prescribe an opioid (33.5%), or led them to prescribe fewer opioid doses (25.5%). Presence of a mandated use policy was significantly associated with increased frequency of PDMP use across a variety of situations, including prior to 1) prescribing any opioid for pain management, 2) issuing refills, 3) prescribing to new patients, and 4) prescribing to patients deemed high risk. Conclusion: Findings suggest that the majority of dentists find PDMPs helpful in informing their opioid-prescribing practices. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists’ PDMP use, outreach and education efforts may overcome key barriers to use identified in this study. Knowledge Transfer Statement: Findings from this national survey suggest that the majority of practicing dentists find PDMPs helpful in informing their opioid-prescribing practices; however, consistent PDMP use was not common. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists’ PDMP use, outreach and education efforts may overcome key barriers to use identified in this study.

Understanding Opioid Prescribing Practices of Resident Physicians

2019 ◽  
Vol 229 (4) ◽  
pp. S116-S117
Author(s):  
Julia M. Coughlin ◽  
Thomas Q. Xu ◽  
Ethan M. Ritz ◽  
Jonathan A. Myers ◽  
Javeria S. Qureshi
Keyword(s):  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Resident Physicians

scholarly journals Opioid Use Disorder: Screening, Diagnosis, and Management

2021 ◽  
Vol 16 (2) ◽  
pp. 25-30
Author(s):  
Privia Randhawa ◽  
Seonaid Nolan
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
The Past ◽  
Opioid Crisis ◽  
Safe Opioid Prescribing

Over the past decade, the opioid crisis in Canada has been worsening. In 2019, over 3,800 people across Canada died due to an apparent opioid-related cause, which represents a 26% increase from just 3 years prior. Given North America’s ongoing opioid crisis, and the contribution opioid-prescribing practices have had to date, a critical need exists to ensure that health care providers are not only educated about safe opioid prescribing but also are knowledgeable about how to effectively screen for, diagnose, and treat an individual with opioid use disorder. RésuméAu cours des dix dernières années, la crise des opioïdes au Canada n’a cessé de s’aggraver. En 2019, plus de 3 800 personnes au Canada sont décédées d’une cause apparemment liée à la consommation d’opioïdes, ce qui représente une augmentation de 26 % par rapport à seulement trois ans auparavant. Étant donné la crise des opioïdes qui sévit actuellement en Amérique du Nord et la contribution des pratiques de prescription d’opioïdes qui ont eu cours jusqu’ici, un besoin critique est à combler pour veiller à ce que les fournisseurs de soins soient non seulement formés sur la prescription sécuritaire des opioïdes, mais aussi bien informés sur le dépistage, le diagnostic et le traitement efficace d’un trouble lié à la consommation d’opioïdes.

A Guide to Coding and Billing for the Audiological Management of Patients Receiving Ototoxic Medical Treatments

2019 ◽  
Vol 4 (5) ◽  
pp. 936-946
Author(s):  
Dawn Konrad-Martin ◽  
Neela Swanson ◽  
Angela Garinis
Keyword(s):  
Otoacoustic Emissions ◽  
Best Practice ◽  
Private Insurance ◽  
Monitoring Program ◽  
Current Method ◽  
International Classification Of Diseases ◽  
Ethical Practice ◽  
Party Payer ◽  
High Frequency Audiometry ◽  
Icd 10

Purpose Improved medical care leading to increased survivorship among patients with cancer and infectious diseases has created a need for ototoxicity monitoring programs nationwide. The goal of this report is to promote effective and standardized coding and 3rd-party payer billing practices for the audiological management of symptomatic ototoxicity. Method The approach was to compile the relevant International Classification of Diseases, 10th Revision (ICD-10-CM) codes and Current Procedural Terminology (CPT; American Medical Association) codes and explain their use for obtaining reimbursement from Medicare, Medicaid, and private insurance. Results Each claim submitted to a payer for reimbursement of ototoxicity monitoring must include both ICD-10-CM codes to report the patient's diagnosis and CPT codes to report the services provided by the audiologist. Results address the general 3rd-party payer guidelines for ototoxicity monitoring and ICD-10-CM and CPT coding principles and provide illustrative examples. There is no “stand-alone” CPT code for high-frequency audiometry, an important test for ototoxicity monitoring. The current method of adding a –22 modifier to a standard audiometry code and then submitting a letter rationalizing why the test was done has inconsistent outcomes and is time intensive for the clinician. Similarly, some clinicians report difficulty getting reimbursed for detailed otoacoustic emissions testing in the context of ototoxicity monitoring. Conclusions Ethical practice, not reimbursement, must guide clinical practice. However, appropriate billing and coding resulting in 3rd-party reimbursement for audiology services rendered is critical for maintaining an effective ototoxicity monitoring program. Many 3rd-party payers reimburse for these services. For any CPT code, payment patterns vary widely within and across 3rd-party payers. Standardizing coding and billing practices as well as advocacy including letters from audiology national organizations may be necessary to help resolve these issues of coding and coverage in order to support best practice recommendations for ototoxicity monitoring.

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

SQIRTS - an on-site stormwater treatment and reuse approach to sustainable water management in Sydney

2002 ◽  
Vol 46 (6-7) ◽  
pp. 151-158 ◽  
Author(s):  
L. Dallmer
Keyword(s):  
Water Management ◽  
Best Practice ◽  
Monitoring Program ◽  
City Council ◽  
Stormwater Treatment ◽  
Stormwater Quality ◽  
Construction Monitoring ◽  
Sustainable Water Management ◽  
Management Approaches ◽  
Main Components

This paper describes part of a program undertaken by South Sydney City Council to promote sustainable water management The aim of the project, named SQIRTS (Stormwater Quality Improvement & Reuse Treatment Scheme) was to demonstrate best-practice water management approaches, to learn from the process of implementing these, and to encourage the further use of these technologies. It comprises three main components located in a suburban park: a gross pollutant trap (GPT), a stormwater reuse system, and interpretative artworks that aim to educate and interpret the water processes within the park. Results from the pre-construction monitoring program are presented.

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