Reducing opioid utilization after urologic oncology surgery.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 269-269 ◽  
Author(s):  
Kerri Stevenson ◽  
Jessica Kee ◽  
Elizna Van Zyl ◽  
Anisia Dugala ◽  
Jay Bakul Shah
Keyword(s):  
Health Care Providers ◽  
High Volume ◽  
Robotic Prostatectomy ◽  
Care Providers ◽  
Opioid Use ◽  
Multiple Sources ◽  
Urologic Oncology ◽  
Surgical Department ◽  
Post Operative Pain ◽  
Opioid Medications

269 Background: Multiple sources have reported on widespread abuse of opioid pain medications among Americans. For many patients, the first encounter with these addictive substances happens when they are prescribed opioids for acute pain management after surgery. Unfortunately, 6% of opioid-naïve patients become newly addicted to opioid medications after surgery. As a high-volume surgical department, we aimed to reduce our reliance on opioid medications to manage post-operative pain by 50% from a baseline morphine equivalent daily dose (MEDD) of 95.1 to a target of 47.5 MEDD. Methods: We retrospectively reviewed daily opioid use, pain scores, and anxiety scores for inpatients recovering from surgery for urologic cancers at our institution over 4 months. We generated process maps, Ishikawa diagrams, and Pareto charts to identify causes contributing to excess opioid use. We designed opioid-sparing pain regimens (using varying combinations of acetaminophen, ketorolac, gabapentin, and local anesthetic) and we identified key drivers required to reliably decrease excess opioid use. Initial interventions were aimed at educating providers and nurses on availability and efficacy of non-opioid medications and later interventions sought to facilitate adoption of the novel pathways. Results: Over the course of this QI project involving 443 patients, the median opioid use per patient decreased 46% from 95.1 to 51.5 MEDD. This reduction in opioid requirements after implementation was successfully achieved across multiple surgery types ranging from robotic prostatectomy (55.1 MEDD) to open radical cystectomy (50.6 MEDD). There was no increase in 24- or 48-hour post-operative pain score associated with use of opioid-minimizing pathways (3.03 vs. 3.04 and 2.92 vs. 2.96, respectively; p > 0.05 for both). Similarly, there was no change in anxiety score at 24- or 48-hours after surgery (0.15 vs. 0.12 and 0.48 vs. 0.30, respectively; p > 0.05 for both). Conclusions: We decreased opioid use after surgery by 46% without compromising pain control. In the nationwide effort to combat the opioid epidemic, health care providers can play a pivotal role as gatekeepers by decreasing reliance on opioids in the post-operative period.

scholarly journals Student Athletic Therapists' Knowledge of Opioids and Other Pain-Relieving Medications

2021 ◽  
Vol 16 (2) ◽  
pp. 112-119
Author(s):  
Jacqueline Vandertuin ◽  
Dalya Abdulla ◽  
Stephanie Lowther
Keyword(s):  
Health Care Providers ◽  
Current Knowledge ◽  
Semistructured Interview ◽  
Care Providers ◽  
Opioid Use ◽  
Contributing Factors ◽  
Correct Information ◽  
News Organizations ◽  
Significant Burden ◽  
Considerable Pressure

Context In their role as health care providers, student athletic therapists (SATs) are responsible for the prevention and management of injuries. To fully understand an injury, SATs require knowledge of contributing factors, including medications and their use and misuse. Opioid misuse by athletes to manage pain has been documented in the literature, highlighting the importance of SATs being able to recognize opioid use and misuse. Opioids are known to alleviate pain, to impair cognition, and to have addictive qualities which prevents appropriate assessment and management of injuries. Objective The objective of this study was to understand SATs' knowledge of pain-relieving medication, particularly opioids. Design Qualitative study. Setting Semistructured interview. Patients or Other Participants SATs at an accredited institution in Canada. Data Synthesis Data were collected through interviews and transcribed. Themes were developed using triangulation that reflected the data Results Four themes were uncovered: (1) SATs had experienced both personal and professional use of opioids, which formulated their current knowledge; (2) SATs lacked appropriate knowledge of pain-relieving medications in general and of the potential consequences of their lack of knowledge; (3) SATs' knowledge stemmed from culture, social media, and news organizations; (4) SATs felt considerable pressure to provide correct information due to their autonomous role with a team. Conclusions SATs lacked enough knowledge to be able to appropriately recognize and advise athletes on pain-relieving medications, particularly opioids. SATs formulated their knowledge and opinions from sources that were not rooted in research and as such may transfer incorrect information to their athletes. SATs stigmatized athletes who were using pain-relieving medication, which may factor into inappropriate decisions regarding an athlete's care. Finally, SATs carried a significant burden to share correct information with their athletes and did not refer to outside sources (eg, physicians) when they were unsure of the information they were sharing with their athletes.

Treatment Persistence Among Insured Patients Newly Starting Buprenorphine/Naloxone for Opioid Use Disorder

2018 ◽  
Vol 52 (5) ◽  
pp. 405-414 ◽  
Author(s):  
Natalia Shcherbakova ◽  
Gary Tereso ◽  
Jacqueline Spain ◽  
Robert J. Roose
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Delivery ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Care Providers ◽  
Opioid Use ◽  
Treatment Persistence ◽  
Factors Associated ◽  
Insured Patients

Background: Persistence with medication-assisted therapy among patients with opioid use disorder has been associated with reduced likelihood of illicit opioid use. Objective: We aimed to describe treatment persistence and identify factors associated with 1-year persistence among insured patients newly initiating buprenorphine-containing pharmacotherapy. Methods: The retrospective observational cohort included employer-sponsored and managed Medicaid patients newly started on buprenorphine-containing therapy between June 30, 2010, and January 1, 2015. Persistence was measured as both a continuous and dichotomous variable (proportion of patients persistent for 1 year). Multivariable logistic regression analysis was used to identify factors associated with 1-year persistence. Results: A total of 302 patients met inclusion criteria. The median [range] number of treatment episodes was 1 [1-4]. Mean number of days on therapy during the first episode was 206 (SD = 152) days, with 40.4% (n = 122) of patients persisting for 1 year. Presence of concomitant fills of prescription opioid analgesics (odds ratio [OR] = 0.25; 95% CI = 0.12-0.51), being in care of an addiction specialist (OR = 0.40; 95% CI = 0.21-0.76), and Medicaid insurance coverage (OR = 0.33; 95% CI = 0.13-0.84) were significantly and negatively associated with 1-year persistence. There was also a strong inverse relationship between persistence and inpatient hospitalization (OR = 0.30; 95% CI = 0.12-0.76). Conclusions: Several health care delivery and use variables were significantly associated with nonpersistence. Concomitant use of prescription opioids is the most easily modifiable risk factor that health care providers and policy makers may act on to improve treatment continuation.

scholarly journals Communication of Recommendations for the Disposal of Unused Prescription Opioid Medications by Stakeholders in the News Media

Pain Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 1711-1716 ◽  
Author(s):  
Megan L Petrik ◽  
Patrick J McNamara ◽  
Susan M Moeschler ◽  
Benjamin D Blair
Keyword(s):  
Health Care ◽  
Law Enforcement ◽  
Health Care Providers ◽  
News Media ◽  
Prescription Opioid ◽  
Environmental Harm ◽  
Prescription Opioids ◽  
Care Providers ◽  
Take Back ◽  
Opioid Medications

Abstract Objective The opioid epidemic is a national public health emergency that requires a comprehensive approach to reduce opioid-related deaths. Proper and timely disposal of unused prescription opioids is one method to deter improper use of these medications and prevent overdose. The objective of this study was to understand how recommendations for disposing of unused prescription opioids, including both take-back programs and toilet disposal, are communicated to the public. Methods Two hundred sixty-three US newspaper articles published between January 1, 2014, and June 30, 2017, containing information on opioids and take-back programs were found using LexisNexis. Using content analysis, articles were coded for the presentation of and recommendation for opioid disposal practices, beliefs about environmental harm from toilet disposal, and additional strategies to reduce opioid supply. The entity responsible for the statement was also captured. Results Take-back programs were presented as a recommended disposal strategy for unused prescription opioids in 88.6% of coded articles. Toilet disposal was presented as a recommended disposal strategy for unused prescription opioids in 3.4% of articles and as harmful to the environment in 16.0% of articles. Individuals from health care, government, and law enforcement were primarily involved in discussing opioid disposal practices. Conclusions Although toilet disposal is recommended by the US Food and Drug Administration (FDA) for disposal of unused prescription opioids when a take-back program is not readily available, it was infrequently presented or recommended in news media articles. These results highlight the importance of improving communication of FDA guidelines for opioid disposal in the media, particularly by health care providers, government employees, and law enforcement officials.

scholarly journals Reducing Alcohol and Opioid Use Among Youth in Rural Counties: An Innovative Training Protocol for Primary Health Care Providers and School Personnel

10.2196/21015 ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. e21015
Author(s):  
Erica Francis ◽  
Kara Shifler Bowers ◽  
Glenn Buchberger ◽  
Sheryl Ryan ◽  
William Milchak ◽  
...  
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Alcohol Use ◽  
Substance Use Disorders ◽  
Health Care Providers ◽  
School Personnel ◽  
Primary Care Providers ◽  
School Nurses ◽  
Care Providers ◽  
Opioid Use

Background Given that youth alcohol use is more common in rural communities, such communities can play a key role in preventing alcohol use among adolescents. Guidelines recommend primary care providers incorporate screening, brief intervention, and referral to treatment (SBIRT) into routine care. Objective The aim is to train primary care providers and school nurses within a rural 10-county catchment area in Pennsylvania to use SBIRT and facilitate collaboration with community organizations to better coordinate substance use prevention efforts. Methods To build capacity to address underage drinking and opioid use among youth aged 9-20 years, this project uses telehealth, specifically Project ECHO (Extension for Community Healthcare Outcomes), to train primary care providers and school nurses to address substance use with SBIRT. Our project will provide 120 primary care providers and allied health professionals as well as 20 school nurses with SBIRT training. Community-based providers will participate in weekly virtual ECHO sessions with a multidisciplinary team from Penn State College of Medicine that will provide SBIRT training and facilitate case discussions among participants. Results To date, we have launched one SBIRT ECHO project with school personnel, enrolling 34 participants. ECHO participants are from both rural (n=17) and urban (n=17) counties and include school nurses (n=15), school counselors (n=8), teachers (n=5), administrators (n=3), and social workers (n=3). Before the study began, only 2/13 (15.5%) of schools were screening for alcohol use. Conclusions This project teaches primary care clinics and schools to use SBIRT to prevent the onset and reduce the progression of substance use disorders, reduce problems associated with substance use disorders, and strengthen communities’ prevention capacity. Ours is an innovative model to improve rural adolescent health by reducing alcohol and opioid use. International Registered Report Identifier (IRRID) DERR1-10.2196/21015

scholarly journals Outcomes from the medication assisted treatment pilot program for adults with opioid use disorders in rural Colorado

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Claudia R. Amura ◽  
Tanya R. Sorrell ◽  
Mary Weber ◽  
Andrea Alvarez ◽  
Nancy Beste ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Rural Areas ◽  
Addiction Severity Index ◽  
Lessons Learned ◽  
Opioid Overdose ◽  
Pilot Program ◽  
Care Providers ◽  
Physical And Mental Health ◽  
Long Term Effects ◽  
Opioid Use

Abstract Background As Colorado ranked among the top nationally in non-medical use of opioids, a pilot medication for opioid use disorder (MOUD) program was developed to increase the number of NPs and PAs providing MOUD in order to bring this evidence- based treatment to 2 counties showing disproportionally high opioid overdose deaths. Over the first 18 months, the MOUD Pilot Program led to 15 new health care providers receiving MOUD waiver training and 1005 patients receiving MOUD from the 3 participating organizations. Here we evaluate patient centered clinical and functional outcomes of the pilot MOUD program implemented in 2 rural counties severely affected by the opioid crisis. Methods Under state-funded law (Colorado Senate Bill 17–074), three rural agencies submitted de-identified patient-level data at baseline (N = 1005) and after 6 months of treatment (N = 190, 25%) between December 2017 and January 2020. The Addiction Severity Index, PhQ9 and GAD-7 with McNemar-Bowker, and Wilcoxon Signed Rank tests analysis were used to measure patient outcomes across after participation in the program. . Results Patients in treatment reported using less heroin (52.1% vs 20.4%), opioids (22.3% vs 11.0%), and alcohol (28.6% vs 13.1%, all P < 0.01). Patients reported improved health (53.4% vs. 68.2%, P = 0.04), less frequency of disability (8.69 vs. 6.51, P = 0.02), symptoms (29.8% vs 21.3%), pain (67.5% to 53.6), worry (45.3% vs 62.3%), anxiety (49.7% vs 23.2%), depression (54.1% vs 23.3%, all P < 0.02) after treatment. Conclusions This study shows decreased substance use, improved physical and mental health, and reduced symptoms after 6 months of MOUD. Although more research on retention and long-term effects is needed, data shows improved health outcomes after 6 months of MOUD. Lessons learned from implementing this pilot program informed program expansion into other rural areas in need to address some of Colorado’ major public health crises.

Health providers’ perspectives on medical marijuana use.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 235-235 ◽  
Author(s):  
Diana Martins-Welch ◽  
Christian Nouryan ◽  
Myriam Kline ◽  
Sony Modayil
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Side Effects ◽  
Health Care Providers ◽  
Prescription Drugs ◽  
Medical Marijuana ◽  
The United States ◽  
Care Providers ◽  
Opioid Use ◽  
Cord Injury

235 Background: According to the CDC, 117 million Americans have one or more chronic health conditions and 31% have used two or more prescription drugs in the past month. Approximately 40% of adults in the United States are using some form of Complementary and Alternative Medicine. Medical marijuana is one such medicine, and to date 29 states have legalized medical marijuana. Methods: A multicenter, anonymous, on-line survey of health care providers was distributed via e-mail within a large health system in the NY Metropolitan area. The survey was distributed in April and May of 2017. The specific aim was to collect information about health care providers’ perspectives on the use of MM in general and for specific medical conditions. Results: The sample (n = 137) consisted of 4% RNs, 10% NPs, 10% fellows, 21% resident physicians, and 52% attending physicians. Average experience was 13 years (range: 0-43), half (53%) were under 40 years old and just over half (56%) were female. Most practitioners recognized a benefit of MM for the treatment of cancer-associated symptoms, few were concerned with side effects and 5% of responders answered that MM was not appropriate at any stage of illness. Responders were “most likely to recommend or refer MM if other therapies were not effective” for cancer (83%), chronic pain (68%), spinal cord injury with spasticity (50%), MS (46%), epilepsy (42%), neuropathy (42%) and Parkinson’s disease (41%). Most providers (77%) believed that MM has the potential to reduce overall opioid use, this was found to be statistically more common in younger providers. The most common conditions that providers reported their patients were requesting MM for were cancer (37%), chronic pain (26%) and neuropathy (10%). The most common concerns about MM use were side effects (16%), addiction (13%), legal consequences (11%), cost (7%) and that other providers would judge MM use (7%). Conclusions: Our survey shows that providers are overwhelmingly in support of MM use in patients with chronic illness, particularly in cancer patients. However providers describe significant and practical concerns about MM utilization. Given the rate at which MM is being legalized throughout the country, it is imperative that there be increased focus on education and clinical studies on MM.

The Importance of a Complete Allergy Assessment in Clinical Stewardship

2019 ◽  
Vol 34 (8) ◽  
pp. 510-513
Author(s):  
Vanessa Moreno ◽  
Charlie L. Nguyen ◽  
Amie Taggart Blaszczyk
Keyword(s):  
Health Care Providers ◽  
Long Term Care ◽  
Care Providers ◽  
Opioid Use ◽  
Term Care ◽  
Care Facilities ◽  
The Right ◽  
Potential Challenge ◽  
Selection Of

National agencies have championed stewardship initiatives to enhance antimicrobial and opioid use in long-term care facilities. Health care providers for these residents have been given the task to ensure "the right drug is used for the right indication at the right time and duration." One potential challenge to this is incorrect or incomplete documentation of allergies. Many long-term care facilities have traditionally, and currently, used a "list format" of allergies in, or on, the resident's chart. This approach is incomplete as it rarely provides detailed information about the reaction to a particular drug. Senior care pharmacists and their students can play a role within long-term care facilities by helping ensure the optimal selection of drugs by providing a detailed allergy assessment that documents detailed reaction information, whenever possible.

Factors Affecting Sexual History Taking in a Health Center Serving Homeless Persons

2018 ◽  
Vol 28 (9) ◽  
pp. 1395-1405
Author(s):  
Timothy Joseph Sowicz ◽  
Christine K. Bradway
Keyword(s):  
Health Care ◽  
Health Center ◽  
Health Care Providers ◽  
Sexual History ◽  
History Taking ◽  
Care Providers ◽  
Opioid Use ◽  
Factors Affecting ◽  
Sexual History Taking ◽  
Sexual Histories

Low rates of documentation of sexual histories have been reported and research on sexual history taking (SHT) has focused on the content of, barriers to collecting, and interventions to improve documentation of sexual histories. Absent from this literature is an understanding of the contextual factors affecting SHT. To address this gap, a focused ethnography of one health center was conducted. Data were collected through observations of health care encounters and interviews with health care providers (HCPs). No SHT was observed and this was likely influenced by patients’ characteristics, communication between patients and HCPs, the prioritization of patients’ basic needs, and time constraints imposed upon encounters. Given that the health center studied serves patients experiencing homelessness, behavioral health concerns, and opioid use disorder, findings illuminate areas for future inquiry into a patient population affected by social as well as physiologic determinants of health and potentially at high risk for adverse sexual health outcomes.

scholarly journals Reducing Alcohol and Opioid Use Among Youth in Rural Counties: An Innovative Training Protocol for Primary Health Care Providers and School Personnel (Preprint)

2020 ◽  
Author(s):  
Erica Francis ◽  
Kara Shifler Bowers ◽  
Glenn Buchberger ◽  
Sheryl Ryan ◽  
William Milchak ◽  
...  
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Alcohol Use ◽  
Substance Use Disorders ◽  
Health Care Providers ◽  
School Personnel ◽  
Primary Care Providers ◽  
School Nurses ◽  
Care Providers ◽  
Opioid Use

BACKGROUND Given that youth alcohol use is more common in rural communities, such communities can play a key role in preventing alcohol use among adolescents. Guidelines recommend primary care providers incorporate screening, brief intervention, and referral to treatment (SBIRT) into routine care. OBJECTIVE The aim is to train primary care providers and school nurses within a rural 10-county catchment area in Pennsylvania to use SBIRT and facilitate collaboration with community organizations to better coordinate substance use prevention efforts. METHODS To build capacity to address underage drinking and opioid use among youth aged 9-20 years, this project uses telehealth, specifically Project ECHO (Extension for Community Healthcare Outcomes), to train primary care providers and school nurses to address substance use with SBIRT. Our project will provide 120 primary care providers and allied health professionals as well as 20 school nurses with SBIRT training. Community-based providers will participate in weekly virtual ECHO sessions with a multidisciplinary team from Penn State College of Medicine that will provide SBIRT training and facilitate case discussions among participants. RESULTS To date, we have launched one SBIRT ECHO project with school personnel, enrolling 34 participants. ECHO participants are from both rural (n=17) and urban (n=17) counties and include school nurses (n=15), school counselors (n=8), teachers (n=5), administrators (n=3), and social workers (n=3). Before the study began, only 2/13 (15.5%) of schools were screening for alcohol use. CONCLUSIONS This project teaches primary care clinics and schools to use SBIRT to prevent the onset and reduce the progression of substance use disorders, reduce problems associated with substance use disorders, and strengthen communities’ prevention capacity. Ours is an innovative model to improve rural adolescent health by reducing alcohol and opioid use. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/21015

Sign in / Sign up

Export Citation Format

Share Document