The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures
| Autor: | Michael P Klueh, Lesly A. Dossett, Michael J. Englesbe, Jay S. Lee, Jennifer F. Waljee, Michael S. Sabel, Chad M. Brummett, Ryan Howard |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Breast biopsy
medicine.medical_specialty medicine.medical_treatment Psychological intervention Breast Neoplasms Inappropriate Prescribing 030230 surgery Drug Prescriptions Article Cohort Studies 03 medical and health sciences 0302 clinical medicine medicine Humans Practice Patterns Physicians' Melanoma Mastectomy Oncologists Pain Postoperative medicine.diagnostic_test business.industry Wide local excision Lumpectomy Prognosis Analgesics Opioid Oncology Opioid 030220 oncology & carcinogenesis Emergency medicine Practice Guidelines as Topic Surgery Female business Oxycodone medicine.drug Cohort study Follow-Up Studies |
| Popis: | BACKGROUND: Excessive opioid prescribing is common in surgical oncology with 72% of prescribed opioids going unused after curative-intent surgery. In this study, we sought to reduce opioid prescribing after breast and melanoma procedures by designing and implementing an intervention focused on education and prescribing guidelines. We then evaluated the impact of this intervention. METHODS: In this single-institution study, we designed and implemented an intervention targeting key factors identified in qualitative interviews. This included mandatory education for prescribers, evidence-based prescribing guidelines, and standardized patient instructions. After the intervention, interrupted time series analysis was used to compare the mean quantity of opioid prescribed before and after the intervention (July 2016-September 2017). We also evaluated the frequency of opioid prescription refills. RESULTS: During the study, 847 patients underwent breast or melanoma procedures and received an opioid prescription. For mastectomy or wide local excision for melanoma, the mean quantity of opioid prescribed immediately decreased by 37% after the intervention (P=0.03), equivalent to 13 tablets of 5mg oxycodone. For lumpectomy or breast biopsy, the mean quantity of opioid prescribed decreased by 42% or 12 tablets of 5mg oxycodone (P=0.07). Furthermore, opioid prescription refills did not significantly change for mastectomy/wide local excision (13% vs. 14%, P=0.8), or lumpectomy/breast biopsy (4% vs. 5%, P=0.7). CONCLUSIONS: Education and prescribing guidelines reduced opioid prescribing for breast and melanoma procedures without increasing the need for refills. This suggests further reductions in opioid prescribing may be possible, and provides rationale for implementing similar interventions for other procedures and practice settings. |
| Databáze: | OpenAIRE |
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