Interventions combining prescriber and patient education, a reduction in default amounts on opioid prescription orders, and increased oversight and accountability of individual prescribers may represent effective strategies for reducing opioid overprescribing, according to a study published in JAMA Network Open.
Data from an acute care hospital, same-day surgery, and outpatient clinics at the Anne Arundel Medical Center in Annapolis, Maryland, were obtained for >44,000 clinical visits per month. Investigators sought to compare pre-intervention baseline levels with a 16-month post-intervention period that ended on April 2018. The main interventions used to reduce opioid prescribing were prescriber education and accountability, reductions in default prescription amounts on opioid prescription orders, professionally written education for patients and the public on opioid risks and alternatives, and improved oversight with measurement of individual prescribers. The study’s primary outcome included the morphine milligram equivalents (MME)/encounter/month, the rate of opioid prescriptions/encounter/month, and MME/opioid prescription.
A decrease of 1.0 MME/encounter/month in the total health system MME/encounter was observed from an initial level of 34.4 MME/encounter/month. At the end of the post-intervention period, the monthly MME/encounter and the MME/prescription/month were found to be 58% and 34% lower, respectively, than average baseline levels. The opioid prescription rate was 38% lower at the end of the intervention period compared with the average level during the 6-month baseline period. Following implementation of the prescription-reduction interventions, patient satisfaction increased from 52% at baseline to 61%.
Study participants were from a single healthcare system within a single electronic medical record system, limiting generalizability of results.
“Meaningful reductions in opioid overprescribing are feasible and sustainable with central coordination and clinical leadership. The tools described in this report are accessible to most health systems,” noted the study authors.
Meisenberg BR, Grover J, Campbell C, Korpon D. Assessment of opioid prescribing practices before and after implementation of a health system intervention to reduce opioid overprescribing. JAMA Network Open. 2018;1(5):e182908.