Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing.

摘要: Importance Overprescribing of opioids has generated and sustains the opioid overdose epidemic. Health systems have a responsibility to lead effort reduce overprescribing. Objective To measure effects multilevel interventions on prescribing within health system. Design, Setting, Participants Quality improvement study comparing 6-month preintervention baseline with 16-month postintervention period ending in April 2018. Inpatient outpatient clinical activity regional system including an acute care hospital, same-day surgery, clinics. Opioid by hundreds clinicians involving over million encounters was measured using system’s electronic medical record. Interventions Multiple parallel different domains, prescriber education accountability, enhanced oversight via measurement individual prescribers, tools right-size postoperative discharge prescriptions, reduction default amounts standard prescription orders, professionally written patient public about risks alternatives. Main Outcomes Measures Morphine milligram equivalents (MME) per encounter month, MME prescription, rate prescriptions (opioid month). Results More than 44 000 month were recorded. All trends not significantly from 0. Total decreased 1.0 month. At end observation period, monthly 58% lower average baseline, 34% less 38% baseline. Conclusions Relevance overprescribing reduced multifocal targeting demand, creating awareness for leadership accountability. The described are adoptable most organized systems. Reducing total supply communities should be given high priority those mission protect improve health.