Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery
| Autor: | Devin Rogers, Kody Armann, Kelly Pekala, Liam C. Macleod, Anup A. Shah, Natalie Pace, Jathin Bandari, Michelle Yu, Hermoon Worku, Bruce L. Jacobs, Avinash Maganty, Jacques E. Chelly, Jonathan G. Yabes, Benjamin J. Davies, Omar Ayyash |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty medicine.medical_treatment Urologists Administration Oral Opioid prescribing Drug Prescriptions Nephrectomy Cohort Studies 03 medical and health sciences 0302 clinical medicine Formal education Intervention (counseling) medicine Hospital discharge Urologic surgery Humans Pain Management 030212 general & internal medicine Patient Reported Outcome Measures Aged Prostatectomy Surgeons Pain Postoperative Morphine business.industry Middle Aged United States Analgesics Opioid Treatment Outcome Oncology Opioid 030220 oncology & carcinogenesis Emergency medicine Female business medicine.drug |
| Zdroj: | Cancer. 127(2) |
| ISSN: | 1097-0142 |
| Popis: | Surgeons play a pivotal role in combating the opioid crisis that currently grips the United States. Changing surgeon behavior is difficult, and the degree to which behavioral science can steer surgeons toward decreased opioid prescribing is unclear.This was a single-institution, single-arm, pre- and postintervention study examining the prescribing of opioids by urologists for adult patients undergoing prostatectomy or nephrectomy. The primary outcome was the quantity of opioids prescribed in oral morphine equivalents (OMEs) after hospital discharge. The primary exposure was a multipronged behavioral intervention designed to decrease opioid prescribing. The intervention had 3 components: 1) formal education, 2) individual audit feedback, and 3) peer comparison performance feedback. There were 3 phases to the study: a pre-intervention phase, an intervention phase, and a washout phase.Three hundred eighty-two patients underwent prostatectomy, and 306 patients underwent nephrectomy. The median OMEs decreased from 195 to 19 in the prostatectomy patients and from 200 to 0 in the nephrectomy patients (P.05 for both). The median OMEs prescribed did not increase during the washout phase. Prostatectomy patients discharged with opioids had higher levels of anxiety than patients discharged without opioids (P.05). Otherwise, prostatectomy and nephrectomy patients discharged with and without opioids did not differ in their perception of postoperative pain management, activity levels, psychiatric symptoms, or somatic symptoms (P.05 for all).Implementing a multipronged behavioral intervention significantly reduced opioid prescribing for patients undergoing prostatectomy or nephrectomy without compromising patient-reported outcomes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text