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OPIOID PRESCRIBING TRENDS IN PROMEDICA HEALTH SYSTEM: A QUALITY ASSURANCE / QUALITY IMPROVEMENT PROJECT
A Alalwan, J Sferra, R Redfern, A Petrak
University of Toledo College of Medicine & Life Sciences

Background
Reaching a balance of effective pain control while avoiding overprescribing opioids is not easily achieved. The current pandemic compounds to this trend either through overuse, chronic use, or diversion to nonmedical use. There still exists a great need for improvement as other studies have found that opioids continue to be overprescribed. In an effort to combat this in conjunction with The ProMedica health systemís responsibility in providing quality care to the community, a review of the surgeons, residents and physician assistantís prescription patterns was initiated. This project aims to analyze if the government and state initiatives along with guidelines had an effect on opioid prescription patterns.

Methods
A cross-sectional longitudinal analysis was conducted to collect prescriptions between January 1, 2016 and December 31, 2019 within ProMedica Health System Hospitals using pharmacy databases, electronic medical records (Epic) and billing databases (Snap Insight/Webi). A generalized linear model and time series analysis was performed to assess the trend of opioid prescriptions (total MME, morphine milligram equivalents) and factors associated with opioid prescriptions.

Results
Among 5647 patients who received opioid prescriptions, there was a significant decrease in the rate for the prescribed opioid amount (total MME) at 6.88% per quarter. The type of surgery, pre-post guidelines, and prescription time were significant factors associated with the final amount of opioid (total MME) [(F value 40.8; p<0.0001), (F Value 8.5; p=0.0036), and (F Value 165.2; p<0.0001)], respectively.

Conclusion
This study concluded that the implementation of government and state initiatives along with practice guidelines was associated with the decrease in postoperative opioid prescribing. The type of surgery performed was the strongest influence. Therefore, we recommend optimizing current guidelines with periodical reviews to ensure patients receive adequate treatment while minimizing over and under-prescribing of narcotic pain medication.


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