Safer and more appropriate opioid prescribing: a large healthcare system's comprehensive approach

• Published in: Journal of evaluation in clinical practice 2017-12, Vol.23 (6), p.1173-1179
• Main Authors: Losby, Jan L., Hyatt, Joel D., Kanter, Michael H., Baldwin, Grant, Matsuoka, Denis
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; California; Chronic Pain - drug therapy; clinical guidelines; Clinical practice guidelines; Continuity of care; Drug overdose; Drug Prescriptions - standards; Drug Utilization - statistics & numerical data; Electronic health records; Electronic Health Records - organization & administration; evidence‐based medicine; Female; Health risk assessment; healthcare; Humans; Inservice Training; Male; Middle Aged; Narcotics; Opioid-Related Disorders - prevention & control; Pain management; Patient safety; Policy; Practice Patterns, Physicians' - statistics & numerical data; Prescriptions; Public health; Quality Improvement - organization & administration; Retrospective Studies; United States; Young Adult
• ISSN: 1356-1294; 1365-2753
• DOI: 10.1111/jep.12756

Rationale, aims, and objectives The United States is in the midst of a public health epidemic with more than 40 people dying each day from prescription opioid overdoses. Health care systems are taking steps to address the opioid overdose epidemic by implementing policy and practice interventions to mitigate the risks of long‐term opioid therapy. Kaiser Permanente Southern California launched a comprehensive initiative to transform the way that chronic pain is viewed and treated. Kaiser Permanente Southern California created prescribing and dispensing policies, monitoring and follow‐up processes, and clinical coordination through electronic health record integration. The purpose of this paper is to describe the implementation of these interventions and assess the impact of this set of interventions on opioid prescribing. Method The study used a retrospective pre‐post evaluation design to track outcomes before and after the intervention. Kaiser Permanente Southern California members age 18 and older excluding cancer, hospice, and palliative care patients and this sub‐population of 3 203 880 was approximately 75% of all Kaiser Permanente Southern California members. All data are from Kaiser Permanente's pharmacy data systems and electronic health record collected on a rolling basis as interventions were implemented from January 2010 to December 2015. Results There were reductions in all tracked outcomes: a 30% reduction in prescribing opioids at high doses; a 98% reduction in the number of prescriptions with quantities greater than 200 pills; a 90% decrease in the combination of an opioid prescription with benzodiazepines and carisoprodol; a 72% reduction in the prescribing of Long Acting/Extended Release opioids; and a 95% reduction in prescriptions of brand name opioid‐acetaminophen products. In addition, methadone prescribing did not increase during this period. Conclusions This study adds promising results that a comprehensive system‐level strategy has the ability to positively affect opioid prescribing. The basic components of the intervention are generalizable and applicable to other health care settings.