Impact of a Personalized Audit and Feedback Intervention on Antibiotic Prescribing Practices for Outpatient Pediatric Community-Acquired Pneumonia

2020 ◽  
Vol 59 (11) ◽  
pp. 988-994 ◽  
Author(s):  
Maria Carmen G. Diaz ◽  
Lori K. Handy ◽  
James H. Crutchfield ◽  
Adriana Cadilla ◽  
Jobayer Hossain ◽  
...  
Keyword(s):  
Positive Impact ◽  
Intervention Group ◽  
Primary Care Providers ◽  
Outpatient Setting ◽  
Community Acquired Pneumonia ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Prescribing Practices ◽  
The Impact

Antibiotic choice for pediatric community-acquired pneumonia (CAP) varies widely. We aimed to determine the impact of a 6-month personalized audit and feedback program on primary care providers’ antibiotic prescribing practices for CAP. Participants in the intervention group received monthly personalized feedback. We then analyzed enrolled providers’ CAP antibiotic prescribing practices. Participants diagnosed 316 distinct cases of CAP (214 control, 102 intervention); among these 316 participants, 301 received antibiotics (207 control, 94 intervention). In patients ≥5 years, the intervention group had fewer non–guideline-concordant antibiotics prescribed (22/103 [21.4%] control; 3/51 [5.9%] intervention, P < .05) and received more of the guideline-concordant antibiotics (amoxicillin and azithromycin). Personalized, scheduled audit and feedback in the outpatient setting was feasible and had a positive impact on clinician’s selection of guideline-recommended antibiotics. Audit and feedback should be combined with other antimicrobial stewardship interventions to improve guideline adherence in the management of outpatient CAP.

scholarly journals A Physician-Driven Quality Improvement Stewardship Intervention Using Lean Six Sigma Improves Patient Care for Community-Acquired Pneumonia

2021 ◽  
Author(s):  
Lea M. Monday ◽  
Omid Yazdanpaneh ◽  
Caleb Sokolowski ◽  
Jane Chi ◽  
Ryan Kuhn ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Six Sigma ◽  
Intervention Group ◽  
Community Acquired Pneumonia ◽  
Lean Six Sigma ◽  
Audit And Feedback ◽  
Control Group ◽  
The Impact

ABSTRACT Introduction The Infectious Diseases Society of America (IDSA) recommends a minimum of 5 days of antibiotic therapy in stable patients who have community-acquired pneumonia (CAP). However, excessive duration of therapy (DOT) is common. Define, measure, analyze, improve, and control (DMAIC) is a Lean Six Sigma methodology used in quality improvement efforts, including infection control; however, the utility of this approach for antimicrobial stewardship initiatives is unknown. To determine the impact of a prospective physician-driven stewardship intervention on excess antibiotic DOT and clinical outcomes of patients hospitalized with CAP. Our specific aim was to reduce excess DOT and to determine why some providers treat beyond the IDSA minimum DOT. Methods A single-center, quasi-experimental quality improvement study evaluating rates of excess antimicrobial DOT before and after implementing a DMAIC-based antimicrobial stewardship intervention that included education, prospective audit, and feedback from a physician peer, and daily tracking of excess DOT on a Kaizen board. The baseline period included retrospective CAP cases that occurred between October 2018 and February 2019 (control group). The intervention period included CAP cases between October 2019 and February 2020 (intervention group). Results A total of 123 CAP patients were included (57 control and 66 intervention). Median antibiotic DOT per patient decreased (8 versus 5 days; p &lt; 0.001), and the proportion of patients treated for the IDSA minimum increased (5.3% versus 56%; p &lt; 0.001) after the intervention. No differences in mortality, readmission, length of stay, or incidence of Clostridioides difficile infection were observed between groups. Almost half of the caregivers surveyed were aware that as few as 5 days of antibiotic treatment could be appropriate. Conclusions A physician-driven antimicrobial quality improvement initiative designed using DMAIC methodology led to reduced DOT and increased compliance with the IDSA treatment guidelines for hospitalized patients with CAP reduced without negatively affecting clinical outcomes.

scholarly journals 142. Impact of an Antimicrobial Stewardship Intervention on Antibiotic Prescribing in Patients with Obstetric Infection and Penicillin Allergy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S86-S86
Author(s):  
Katelyn Quartuccio ◽  
Kelly Golden ◽  
Brenda L Tesini ◽  
Eric Heintz ◽  
Neil Seligman ◽  
...  
Keyword(s):  
Positive Impact ◽  
Group B Streptococcus ◽  
Intervention Group ◽  
Penicillin Allergy ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
Post Intervention ◽  
Early Onset Sepsis ◽  
Group B ◽  
The Impact

Abstract Background Antibiotics are commonly administered in the peripartum period and most patients with penicillin allergy can tolerate beta lactams, which are preferred for the prophylaxis and treatment of several common obstetric infections. The purpose of this study was to evaluate the impact of a stewardship intervention bundle (including updates to institutional antibiotic guidelines, reclassification of severe penicillin allergy, development of order sets, and a physician champion) on the management of obstetric infections in patients with reported penicillin allergy. Methods This was a multicenter, retrospective study of adult patients presenting for labor and delivery who received at least one dose of antibiotics for an infectious indication May 1, 2018 to October 31, 2018 (pre-intervention) and May 1 2020 to October 31, 2020 (post-intervention). The primary outcome was the composite rates of patients with a reported penicillin allergy who received a preferred agent for Group B Streptococcus (GBS) prophylaxis, intraamniotic infection, or cesarean surgical site infection (SSI) prophylaxis. Results A total of 192 patients with a documented penicillin allergy were evaluated (96 patients each in pre- and post-intervention groups). Hives were the most commonly reported allergy in both groups (40% vs 39%, P=0.883). Following stewardship interventions, there was a significant increase in the rate of preferred antibiotics prescribed to patients with penicillin allergy (34.3% vs 84.3%, P&lt; 0.001), driven mainly by patients with non-severe allergy (18.4% vs 82.9%, P&lt; 0.001). There were non-statistically significant trends toward lower rates of postpartum endometritis, 30-day readmission, 90-day SSI, and neonatal early onset sepsis. Allergic reactions in the post-intervention group were limited to itching and rash in one patient each; both resolved with medical management. Conclusion A comprehensive antibiotic stewardship intervention increased preferred antibiotic prescribing for treatment and prophylaxis of obstetric infections. Pregnant patients with non-severe penicillin allergies, even those reporting hives, can tolerate beta-lactam antibiotics. The potential positive impact on clinical outcomes warrants additional investigation. Disclosures Neil Seligman, MD, Natera (Consultant)UpToDate (Other Financial or Material Support, Author)

scholarly journals A pragmatic randomized trial of a primary care antimicrobial stewardship intervention in Ontario, Canada

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Warren McIsaac ◽  
Sahana Kukan ◽  
Ella Huszti ◽  
Leah Szadkowski ◽  
Braden O’Neill ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Care Provider ◽  
Primary Care Provider ◽  
Antibiotic Use ◽  
Primary Care Providers ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Tract Infections

Abstract Background More than 90% of antibiotics are prescribed in primary care, but 50% may be unnecessary. Reducing unnecessary antibiotic overuse is needed to limit antimicrobial resistance. We conducted a pragmatic trial of a primary care provider-focused antimicrobial stewardship intervention to reduce antibiotic prescriptions in primary care. Methods Primary care practitioners from six primary care clinics in Toronto, Ontario were assigned to intervention or control groups to evaluate the effectiveness of a multi-faceted intervention for reducing antibiotic prescriptions to adults with respiratory and urinary tract infections. The intervention included provider education, clinical decision aids, and audit and feedback of antibiotic prescribing. The primary outcome was total antibiotic prescriptions for these infections. Secondary outcomes were delayed prescriptions, prescriptions longer than 7 days, recommended antibiotic use, and outcomes for individual infections. Generalized estimating equations were used to estimate treatment effects, adjusting for clustering by clinic and baseline differences. Results There were 1682 encounters involving 54 primary care providers from January until May 31, 2019. In intervention clinics, the odds of any antibiotic prescription was reduced 22% (adjusted Odds Ratio (OR) = 0.78; 95% Confidence Interval (CI) = 0.64.0.96). The odds that a delay in filling a prescription was recommended was increased (adjusted OR=2.29; 95% CI=1.37, 3.83), while prescription durations greater than 7 days were reduced (adjusted OR=0.24; 95% CI=0.13, 0.43). Recommended antibiotic use was similar in control (85.4%) and intervention clinics (91.8%, p=0.37). Conclusions A community-based, primary care provider-focused antimicrobial stewardship intervention was associated with a reduced likelihood of antibiotic prescriptions for respiratory and urinary infections, an increase in delayed prescriptions, and reduced prescription durations. Trial registration clinicaltrials.gov (NCT03517215).

scholarly journals 135. Designing And Evaluating A Pharmacist-Driven Approach to Outpatient Azithromycin Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S79-S79
Author(s):  
Christina Tran ◽  
Paul Lata ◽  
Kristin Tindall ◽  
Susanne Barnett ◽  
Prakash Balasubramanian
Keyword(s):  
Antimicrobial Agents ◽  
Respiratory Infections ◽  
Negative Impact ◽  
Primary Care Providers ◽  
Outpatient Setting ◽  
Care Providers ◽  
Prescribing Practices ◽  
Copd Exacerbations ◽  
Post Hoc

Abstract Background After collecting data on diminishing S. pneumoniae susceptibility rates, the Madison VA aimed to optimize azithromycin prescribing practices by enhancing the involvement of outpatient pharmacists. This study aimed to develop effective pharmacy-led stewardship teams in the outpatient setting and assess their collective impact on promoting judicious azithromycin prescribing. Methods Madison VA outpatient pharmacists initiated an azithromycin stewardship protocol in 4/2019 to intervene on prescriptions suspected to be discordant with expert guidelines for COPD, pneumonia, sinusitis, or bronchitis. After pharmacist follow-up with providers to discuss potentially inappropriate prescriptions, recommendations and outcomes were subsequently documented in the electronic health record. Given the longitudinal nature of outpatient pharmacist interventions, a post-hoc survey was provided to assess pharmacists’ perceptions of this protocol, barriers to intervention, and areas for improvement. Results Between 10/2018 and 4/2020, 18 pharmacists intervened on 42 outpatient azithromycin prescriptions to recommend alternative antibiotics with improved streptococcal coverage or supportive care alone. Indications warranting the most intervention included COPD exacerbations, upper respiratory infections, and bronchitis. Factors most often cited by pharmacists as barriers to intervention included negative impact on workload, provider reluctance, and insufficient time for follow-up. All surveyed pharmacists believed that prescribers, most commonly primary care providers, were fairly or very receptive to their recommendations. Data evaluated from 10/2018 to 12/2019 revealed a 45% decrease in azithromycin prescribing. Conclusion Azithromycin prescribing has steadily declined at the Madison VA, reinforced by the implementation of an outpatient pharmacist stewardship team. To more seamlessly integrate recommendation-making into pharmacist workflow, determining solutions to identified barriers is currently underway. It is hoped that continued pharmacist involvement in outpatient antibiotic stewardship can be a sustainable practice and transferrable strategy to other antimicrobial agents in the future. Disclosures All Authors: No reported disclosures

scholarly journals 75. Less is More: A Physician-Driven Quality Improvement Stewardship Initiative to Reduce Excessive Duration of Antibiotic Therapy in Veterans Hospitalized with Community-Acquired Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S55-S56
Author(s):  
Lea M Monday ◽  
Omid Yazdanpanah ◽  
Caleb Sokolowski ◽  
Joseph Sebastian ◽  
Ryan Kuhn ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Community Acquired Pneumonia ◽  
Audit And Feedback ◽  
Patient Specific ◽  
Control Group ◽  
Less Is More ◽  
Historic Control ◽  
The Impact

Abstract Background The IDSA and American Thoracic Society (IDSA/ATS) Community Acquired Pneumonia (CAP) guidelines recommend 5 days of therapy for clinically stable patients that defervesce, however, duration of therapy (DOT) is often longer. Pharmacists curb this via antimicrobial stewardship (AMS), but budgetary constraints are barriers to robust AMS programs in some hospitals. Physicians are increasingly encouraged to participate in quality improvement (QI) and are a potential resource to improve AMS. We sought to determine the impact of a prospective, physician-driven stewardship intervention on DOT and clinical outcomes in hospitalized veterans with CAP, with the goal to reduce the median DOT by at least 1 day within 5 months. Methods This single center, quasi-experimental QI study evaluated two concurrent physician-driven interventions over a 5-month period in an inner-city Veterans Affairs Hospital. Using DMAIC (Define, measure, analyze, improve, and control) methodology, the Chief Resident in Quality and Safety (CRQS) provided monthly education and daily audit and feedback with patient-specific DOT recommendations. Clinical outcomes were followed until 30 days post discharge. Results A total of 123 patients with CAP were included (57 in the historic control group and 66 in the AMS intervention group). The AMS intervention significantly increased the proportion of CAP patients treated with a 5-day treatment course (56% versus 5.3%, p&lt; 0.0001), and reduced the proportion of patients treated beyond 7 days (12.1% versus 70.2%, p&lt; 0.0001). Median DOT per patient was reduced significantly (5 versus 8 days, p&lt; 0.0001). Median excess antibiotic days were significantly reduced (0 versus 3, p&lt; 0.0001) and 118 days of unnecessary antibiotics were avoided (62 versus 180). 30-day all-cause mortality, all-cause readmission, and Clostridium difficile infection were similar between groups. Median LOS was similar between groups (p=0.246). DOT in the Historic Control Group Versus Stewardship Intervention Group Conclusion A physician driven QI stewardship intervention in hospitalized CAP patients significantly reduced the total antibiotic DOT and excess antibiotic days without adversely affecting patient outcomes. Providers can be educated through physician driven interventions resulting in substantial improvements in appropriate antibiotic use. Disclosures All Authors: No reported disclosures

scholarly journals Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports

2019 ◽  
Vol 8 (1) ◽  
pp. e000351 ◽  
Author(s):  
Richard V Milani ◽  
Jonathan K Wilt ◽  
Jonathan Entwisle ◽  
Jonathan Hand ◽  
Pedro Cazabon ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Education ◽  
Test Group ◽  
Primary Care Providers ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Normative Comparison ◽  
Second Year ◽  
Tract Infections ◽  
The Impact

ImportanceAntibiotic resistance is a global health issue. Up to 50% of antibiotics are inappropriately prescribed, the majority of which are for acute respiratory tract infections (ARTI).ObjectiveTo evaluate the impact of unblinded normative comparison on rates of inappropriate antibiotic prescribing for ARTI.DesignNon-randomised, controlled interventional trial over 1 year followed by an open intervention in the second year.SettingPrimary care providers in a large regional healthcare system.ParticipantsThe test group consisted of 30 primary care providers in one geographical region; controls consisted of 162 primary care providers located in four other geographical regions.InterventionThe intervention consisted of provider and patient education and provider feedback via biweekly, unblinded normative comparison highlighting inappropriate antibiotic prescribing for ARTI. The intervention was applied to both groups during the second year.Main outcomes and measuresRate of inappropriate antibiotic prescription for ARTI.ResultsBaseline inappropriate antibiotic prescribing for ARTI was 60%. After 1 year, the test group rate of inappropriate antibiotic prescribing decreased 40%, from 51.9% to 31.0% (p<0.0001), whereas controls decreased 7% (61.3% to 57.0%, p<0.0001). In year 2, the test group decreased an additional 47% to an overall prescribing rate of 16.3%, and the control group decreased 40% to a prescribing rate of 34.5% after implementation of the same intervention.Conclusions and relevanceProvider and patient education followed by regular feedback to provider via normative comparison to their local peers through unblinded provider reports, lead to reductions in the rate of inappropriate antibiotic prescribing for ARTI and overall antibiotic prescribing rates.

scholarly journals 230. Impact of 10-day versus 5-day Duration Default on Length of Antibiotic Outpatient Prescriptions from the Emergency Department

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Amber M Watts ◽  
Shannon Holt
Keyword(s):  
Emergency Department ◽  
Intervention Group ◽  
Community Acquired Pneumonia ◽  
Transitions Of Care ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
The Mean ◽  
Dental Infections ◽  
The Impact ◽  
Outpatient Prescriptions

Abstract Background Antimicrobial stewardship programs (ASP) traditionally focus on inpatient care; however there is a growing effort to optimize antibiotic prescribing at transitions of care. Longer than necessary discharge prescriptions increase risk of antimicrobial resistance, C. difficile infection and adverse events. In order to minimize unnecessary antibiotic exposure, the health system updated the electronic medical record (EMR) outpatient antibiotic prescription default from 10 days to 5 days. The objective of this study was to assess the impact of a 10-day versus 5-day EMR antibiotic outpatient prescriptions default on length of therapy for patients discharged from the Emergency Department (ED). Methods This is a retrospective, single-system cohort study evaluating ED discharge prescriptions before and after transition from a default duration of 10 days to 5 days. Discharge prescriptions were collected and screened from December 2019 through January 2020 in the control group and March 2020 through April 2020 in the intervention group. Outpatient prescriptions were included for primary diagnoses of urinary tract infection (UTI), community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), diverticulitis, or dental infections. The primary outcome was the incidence of prescriptions written for a &lt; 5 day duration. Results The study included 3060 of 9651 (32%) prescriptions in the control group and 1610 of 4938 (33%) prescriptions in the intervention group. The mean age was 38 years old with 61% female. The most common primary diagnoses were SSTI (n=1633, 35%) and UTI (n=1633, 32%). The mean duration for discharge prescriptions was similar between groups (8.44 vs. 8.30 days). The incidence of outpatient antibiotic prescriptions for &lt; 5 days was not significantly different between groups (10.72% vs 10.56%, p=0.996). There was an improvement in duration of therapy, with more prescriptions &lt; 5 days for SSTI (2.96% vs. 7.64%, p=0.860) and dental infections (3.30% vs. 10.86%, p=0.808). Conclusion Implementation of a shorter default duration for antibiotic outpatient prescriptions from the ED did not significantly increase the incidence of prescriptions written for &lt; 5 days. There was an improvement in duration for SSTI and dental infections after implementation. Disclosures All Authors: No reported disclosures

scholarly journals 43 Addressing Polypharmacy in the Frail Older Person - the WIDE (Wholistic, Integrated, Deprescribing, Evaluation) Review

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Clare Kinahan ◽  
Nazir Soomro ◽  
Florrie Daniels ◽  
Wafaa Hussain ◽  
Helen Heery
Keyword(s):  
Medication Review ◽  
Hospital Pharmacist ◽  
Intervention Group ◽  
Cost Savings ◽  
Primary Care Providers ◽  
Control Group ◽  
Care Providers ◽  
Start Criteria ◽  
The Impact ◽  
Medication Appropriateness

Abstract Background People are living longer, with more chronic conditions and are prescribed more medications according to disease specific guidelines. The WIDE Review is an innovative model of comprehensive medication review devised to treat the whole patient. Frail patients are twice as likely to be prescribed inappropriate medications and are more vulnerable to their harmful effects. Use of the STOPP/START criteria and the Medication Appropriateness Index (MAI) have been shown to improve patient outcomes. This study examined the impact and cost effectiveness of pharmacist led WIDE Reviews. Methods This quantitative prospective cohort study was conducted over 8 weeks in a Model 3 hospital. Inclusion criteria: inpatients age > 65 years; prescribed > 6 regular medications and screened positive for frailty (PRISMA 7 score >3). Critically ill patients were excluded. Eligible patients were randomly allocated to intervention or control group. The intervention group received a pharmacist led WIDE Review: Wholistic (establishing patients' priorities), Integrated (collaborating with primary care providers), Deprescribing Evaluation of medication harms versus benefits. Medications were screened using the STOPP/START criteria and the MAI was calculated. In conjunction with the patients and their consultants, deprescribing plans were devised and communicated to their GPs and community pharmacists Results A total of 20 intervention and 20 control group patients were enrolled. Patient characteristics (age, sex and length of stay) were similar for both groups. 65% of STOPP and 62% of START criteria were addressed in the intervention group versus 12% and 5% respectively in the control group. In the intervention group 83 medications were stopped, 23 dose reduced and the total MAI score was reduced by 64%. Cost savings to the annual drug budget alone represented a 9:1 return on investment of hospital pharmacist time. Conclusion Pharmacists performing WIDE Reviews significantly improved medication appropriateness and realised compelling cost savings. A larger scale study of this innovative approach to medication review is planned.

Antimicrobial Resistance Education in the Primary Care Setting

2016 ◽  
Vol 9 (2) ◽  
pp. 217-225
Author(s):  
Jenna Oesterle ◽  
Meghan Sternemann ◽  
Tiffany Sande ◽  
Christina Aplin-Kalisz ◽  
Diane Towers
Keyword(s):  
Primary Care ◽  
Antimicrobial Resistance ◽  
Educational Intervention ◽  
Treatment Guidelines ◽  
Primary Care Providers ◽  
National Committee ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Prescribing Practices ◽  
Convenience Sample

Background:Antimicrobial resistance has become a problem of epidemic proportions; however, patients believe antibiotics can treat any infection (National Committee for Quality Assurance [NCQA], 2011). Judicious prescribing practices are known to decrease antimicrobial resistance in the community (Centers for Disease Control [CDC], 2012).Purpose:Primary care providers (PCPs) are in a position to change current prescribing practices and patient beliefs regarding antimicrobials. This project focused on a PCP-facilitated educational intervention.Design/Methods:A quasi-experimental chart review performed over 3 months. PCPs were educated on CDC treatment guidelines for acute bronchitis, sinusitis, pharyngitis, and the educational pamphlet. The PCPs provided a brief educational session with the pamphlet to patients presenting with upper respiratory infections (URIs).Sample:A convenience sample of patients 18–64 years old presenting with URI symptoms; data were collected on antibiotic prescriptions, patient demographics, comorbid diagnoses, and discharge diagnosis.Results:Antibiotic prescribing rates for patient’s pre- to postintervention decreased significantly from 77.9% to 61.6% (1,N= 163) = 0.02,p< .05. Improved adherence to guidelines from pre- to postintervention for bronchitis was demonstrated yet no statistically significant improvement for pharyngitis and sinusitis.Conclusion:A PCP-facilitated educational intervention demonstrated an effective method to reduce antibiotic prescriptions for URIs in primary care.

Primary care providers’ prescribing practices of opioid controlled substances

2016 ◽  
Vol 12 (6) ◽  
pp. 397 ◽  
Author(s):  
Lisa B. E. Shields, MD ◽  
Soraya Nasraty, MD, MMM, CPE ◽  
Alisha D. Bell, MSN, RN, CPN ◽  
Anil N. Vinayakan, MD ◽  
Raghunath S. Gudibanda, MD ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Health Concern ◽  
Care Providers ◽  
Office Visits ◽  
Prescribing Practices ◽  
Controlled Substances ◽  
Average Percentage ◽  
Controlled Substance ◽  
The Impact

Objective: Prescription opioid abuse poses a significant public health concern. House Bill 1 (HB1) was enacted in 2012 to address prescription drug abuse in Kentucky. The authors investigated the impact of HB1 on primary care providers’ (PCPs) prescribing practices of Schedule II controlled substances. Design: Retrospective evaluation of PCPs’ prescribing practices in an adult outpatient setting.Methods: A review of the prescribing practices for Schedule II controlled substances written by 149 PCPs. The number of prescriptions for Schedule II controlled substances written by 149 PCPs was compared to the top 10 PCP prescribers. Attention was focused on providers who wrote for oxycontin and/or opana and prescriptions with > 90 pills dispensed.Results: The top 10 PCP prescribers accounted for 38.4 percent of the Schedule II controlled substances and 47.8 percent of the Schedule II controlled substances with > 90 pills dispensed. Of the 60 PCPs who prescribed opana and/or oxycontin, the average number of prescriptions was 14.7 compared to 51.0 for the top 10 PCP prescribers. The average percentage of Schedule II controlled substance prescriptions compared to the total number of prescriptions was 27.9 percent for the top 10 PCP prescribers and 7.05 percent of all PCPs. The average percentage of office visits with Schedule II controlled substance prescriptions compared to total office visits was 24.8 percent for the top 10 PCP prescribers versus 7.7 percent for all PCPs.Conclusions: Further scrutiny is warranted to more closely analyze provider opioid prescribing habits and ensure that the providers at our Institution are prescribing Schedule II controlled substances in compliance with HB1.

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