To promote patient safety, quality of care, and adherence to practice guidelines for safely prescribing opioids for chronic noncancer pain in the United States, Ochsner Health System implemented a multicomponent electronic medical record clinical decision support (EMR CDS) system in accordance with the 2016 US Centers for Disease Control and Prevention guideline. The EMR CDS directly targeted providers to increase awareness of best practices within their usual workflow. It incorporated an opioid health maintenance tool to display the status of risk mitigation, and the medication order embedded the morphine equivalent daily dose calculator and a hyperlink to the Louisiana pharmacy drug monitoring program.
After incorporation of the EMR CDS system, patients had higher rates of urine drug screens and naloxone prescriptions. In addition, specialty referrals to physical or occupational therapy, orthopedics, neurology, and psychiatry or psychology increased in the postintervention period. Although emergency department use decreased, hospitalization rates did not change. Furthermore, implementation of the EMR CDS did not change the main outcome of interest, namely, rates of prescribing high-dose opioids.
“Given the nationwide opioid crisis, health systems and providers must urgently find ways to extend opioid management beyond standardized monitoring of risk factors for misuse or abuse and set clear protocols for next steps in chronic care management,” said author Eboni G. Price-Haywood, MD, MPH, director, Center for Outcomes and Health Services Research, Ochsner Health System, New Orleans, LA, USA. “In this article, we show that technology optimization targeting providers may improve some aspects of opioid risk mitigation but may not as a single intervention change opioid-prescribing behaviors. Multilevel interventions that concurrently target patients, providers, health systems, and health policy are likely to be more effective.”
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