Prescriber transparency reduced opioid prescriptions at UCSF after orthopedic surgery
LAS VEGAS — Use of a goal-directed opioid reduction strategy successfully reduced opioid prescriptions at discharge at one institution with no significant increase in post-discharge refill rates, according to results presented at the American Academy of Orthopaedic Surgeons Annual Meeting.
As part of an institutional quality improvement initiative, Trevor Grace, MD, and colleagues at the University of California, San Francisco aimed to reduce the median discharge opioid prescriptions by 10% compared to the preceding 6-months in the department of orthopedic surgery. Prescribers received feedback every 6 weeks summarizing their progress toward reaching the established goal, as well as advice on providing multimodal, non-narcotic pain management strategies.
Reduction in opioid prescriptions
Using an institutional clinical database, researchers collected and quantified opioid prescription data between patients treated during the 6-month study period (n=429) and patients treated 6-months prior to the initiative (n=401). Demographic and inpatient data, pre-discharge opioid requirements, discharge prescription quantities and post-discharge refill rates were compared between the two groups.
“There was a significant decline in the median discharge opioid prescription for the entire cohort, as well as for all subspecialties except for sports [medicine] and spine,” Grace told Healio.com/Orthopedics.
Although opioids consumed by patients in the hospital 24 hours before discharge were comparable between both groups, in his presentation Grace noted a significantly lower quantity of discharge prescriptions in the intervention group.
“Post-discharge refill rates were comparable between the intervention group and the pre-intervention group at all time points,” Grace said.
Benefits of transparency, education
Grace said he believes the transparency of their initiative helped prompt the behavioral change in prescribers. He added that the presence of this initiative provided an incentive to teach patients about the dangers of excessive opioid prescriptions and that they often do not need as many opioids for pain management which also helped reduce prescriptions.
“Patients often request large quantities of opioid pills on discharge as they interpret this as a lower chance of postoperative pain. They often do not acknowledge the dangers of excessive prescriptions,” Grace said. “Our opioid reduction initiative gave providers leverage to counter these requests for more pills, and to engage in meaningful dialogue on why we need to give less.”
According to Grace, the next step is to get more post-discharge information, such as how many opioids patients are consuming postoperatively. He noted his institution has begun collecting data on how many opioids patients are taking day-to-day postoperatively and comparing that to how many opioids have been prescribed.
“[Surgeons or providers should] try to tailor the discharged prescriptions to patient needs because we are trying to minimize the number of leftover unused pills out there that could be misused or diverted to some non-medical purpose, like recreational use,” Grace said. – by Casey Tingle
Grace TR, et al. Abstract 459. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 12-16, 2019; Las Vegas.
Disclosure: Grace reports no relevant financial disclosures.