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.

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.

Cost Impact of Switching Histamine2-Receptor Antagonists to Nonprescription Status

2002 ◽  
Vol 36 (7-8) ◽  
pp. 1135-1141 ◽  
Author(s):  
Michelle D Furler ◽  
Mark S Rolnick ◽  
Kathleen S Lawday ◽  
Miranda W Mak ◽  
Thomas R Einarson
Keyword(s):  
Market Share ◽  
Insurance Coverage ◽  
Consumer Price Index ◽  
Population Data ◽  
Status Change ◽  
Prescribing Practices ◽  
Receptor Antagonists ◽  
The Us ◽  
The Uk ◽  
The Impact

BACKGROUND: There is a recent trend to switching medications from prescription to nonprescription status. Often, such switches are accompanied by dramatic changes in utilization due to increased availability or decreased insurance coverage. The histamine2-receptor antagonists (H2RAs) underwent such status change in the UK in 1994, the US in 1995, and Canada in 1996. OBJECTIVE: To examine the impact of the status change for H2RAs on the market for gastrointestinal (GI) agents in the US, UK, and Canada. METHODS: IMS market sales data from 1992 to 1997 were procured. All costs were converted to 1997 US dollars using the consumer price index. Per capita sales figures were determined using population data from the US Census Bureau's International Database. RESULTS: Overall spending on GI remedies increased in all 3 markets between 1992 and 1997; however, the contribution of prescription sales and number of prescriptions varied across the 3 countries. An increased market share for nonprescription H2RAs occurred in the US, correlating with a decline in prescription numbers for GI remedies. The opposing trend occurred in the UK, where market share of nonprescription H2RAs was minimal and use of prescription H2RAs increased. Prescription and nonprescription H2RA sales could not be differentiated for Canada. CONCLUSIONS: The impact of the H2RA status change varied across countries. Differences in utilization may be attributed to many factors such as differing healthcare systems, patient convenience, and physician prescribing practices. Further research is required to identify the reasons for differences in utilization and to quantify the potential clinical impact.

scholarly journals Five-year follow-up of an evidence-based prescribing intervention

2008 ◽  
Vol 32 (5) ◽  
pp. 183-186 ◽  
Author(s):  
David Meagher ◽  
Ananth Pullela ◽  
Marek Meisinger ◽  
Niamh Geaney ◽  
Sinead O'Brien
Keyword(s):  
Clinical Implications ◽  
High Dose ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practices ◽  
Multidisciplinary Intervention ◽  
Prescribing Practice ◽  
Multifaceted Interventions ◽  
The Impact

Aims and MethodWe studied the impact of an evidence-based multidisciplinary intervention to reduce six sub-optimal aspects of psychotropic prescribing, combined as a Prescribing Practice Quality (PPQ) score over a 5-year follow-up period in a community mental health service.ResultsSub-optimal prescribing practices were significantly reduced after 1 year and these improvements were sustained at 5-year follow-up. The PPQ scores were significantly reduced (P<0.001) in both the overall population attending at each follow-up point as well as in the ever-present population (n=163). Use of high-dose antipsychotics and thioridazine ceased entirely; use of sedative hypnotic agents was less amenable to reduction.Clinical ImplicationsMultifaceted interventions can achieve sustained improvements in prescribing practices in real-world settings.

scholarly journals 978. Assessing the Impact of a Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S40-S40
Author(s):  
Katherine Richardson ◽  
Sarah Fouquet ◽  
Ellen Kerns ◽  
Russell Mcculloh
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Mental Workload ◽  
Clinical Decision ◽  
Medical Decision ◽  
Evidence Based ◽  
System Usability Scale ◽  
Nasa Tlx ◽  
Evidence Based Guidelines ◽  
The Impact

Abstract Background Fever in infants &lt;90 days old can indicate a serious bacterial infection (SBI) such as urinary tract infection, bacteremia, or meningitis. Clinical management of febrile infants varies widely. Implementing clinical practice guidelines (CPGs) can help standardize care, and electronic clinical decision support (eCDS) tools are a potential means of distributing CPGs. Little is known regarding the individual-level impact of eCDS tool use on medical decision-making. Children’s Mercy Kansas City developed a mobile eCDS tool (CMPeDS: Pediatric Decision Support) that was used internationally in a practice standardization project focused on the management of febrile infants. Methods We conducted a prospective cross-over simulation study amongst pediatric healthcare providers. Attending and resident physicians performed simulated patient scenarios using either CMPeDS or a standard text reference (the Harriet Lane Handbook). Participants’ responses in the simulation were evaluated based on adherence to evidence-based guidelines. Participants’ mental workload was assessed using the NASA Task Load Index survey (NASA-TLX, in which lower scores are optimal) to assesses mental, physical, and temporal demand, as well as performance, effort, and frustration when completing a series of tasks. Paired t-test and ANOVA were used to determine significance for case performance scores and NASA-TLX scores, respectively. A System Usability Scale (SUS) was used to determine usability of the CMPeDS app. Results A total 28 of 32 planned participants have completed trial procedures to date. Mean performance scores on the cases were significantly higher with CMPeDS vs. standard reference, (87.7% vs. 72.4% [t(27) 3.22, P = 0.003]). Participants reported lower scores on the NASA-TLX when using CMPeDS compared with standard reference tool (Figure 1). Mean score on SUS was 88.2 (scale 0–100) indicating excellent tool usability (Figure 2). Conclusion Using the eCDS tool CMPeDS was associated with significantly increased adherence to evidence-based guidelines for febrile infant management and decreased mental workload in simulation. Our findings highlight the potential value of eCDS deployment as part of CPG implementation projects. Disclosures All authors: No reported disclosures.

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.

scholarly journals Experiences of telehealth in general practice in Australia: research protocol for a mixed methods study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0187
Author(s):  
Sarah J White ◽  
Amy Nguyen ◽  
Peter Roger ◽  
Tim Tse ◽  
John A Cartmill ◽  
...  
Keyword(s):  
General Practice ◽  
Conversation Analysis ◽  
General Practitioners ◽  
Direct Evidence ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Practice Setting ◽  
Australian General Practice ◽  
Evidence Based Guidelines ◽  
The Impact

BackgroundDue to the COVID-19 pandemic, use of telehealth has expanded rapidly. However, little is known about the impact of delivering care through telehealth on communication between clinicians and patients. At an interactional level, the ways in which clinicians establish rapport and connection with their patients in telehealth consultations is not well understood.AimThis study will explore interactional practices of general practitioners (GPs) and patients in telehealth consultations to develop evidence-based resources to improve communication.Design & settingThe study will be conducted within the Australian general practice setting.MethodConversation analysis and sociolinguistic discourse analysis of recorded telehealth consultations will provide direct evidence of specific elements contributing to successful and less successful instances of telehealth communication. This analysis will be complemented by co-design techniques such as qualitative and reflective interviews and collaborative workshops with telehealth users, including both general practitioners and patients.ConclusionEffective communication is critical for telehealth consultations and is central to achieving optimal clinical outcomes and patient satisfaction. This study will co-develop with end-users, evidence-based guidelines encompassing effective telehealth communication strategies.

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