Journal of opioid management最新文献

A toolkit to implement opioid quality improvement efforts in primary care: Findings from a mixed-methods study.

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0894

Ellen Childs, Holly Swan, Leigh Evans, Michael L Parchman, Brooke Ike, Laura-Mae Baldwin, Olivia Bacon, Deborah Perfetto, Eileen Hogan, Sarah J Shoemaker-Hunt

{"title":"A toolkit to implement opioid quality improvement efforts in primary care: Findings from a mixed-methods study.","authors":"Ellen Childs, Holly Swan, Leigh Evans, Michael L Parchman, Brooke Ike, Laura-Mae Baldwin, Olivia Bacon, Deborah Perfetto, Eileen Hogan, Sarah J Shoemaker-Hunt","doi":"10.5055/jom.0894","DOIUrl":"https://doi.org/10.5055/jom.0894","url":null,"abstract":"Objective: The Six Building Blocks: A Team-Based Approach to Improving Opioid Management in Primary Care (6BBs) program provides a roadmap for improving the management of patients on opioid therapy for chronic pain. The goal of this project was to evaluate the How-to-Implement Toolkit (Toolkit) for clinics to independently implement the 6BBs without a practice facilitator.Methods: Eight healthcare organizations with 62 clinics participated in the program. We conducted interviews and surveys with clinical staff. A mixed-methods synthesis was conducted, incorporating themes from qualitative data and descriptive analysis of survey data.Results: We found that healthcare organizations appreciated the resources in the Toolkit but wanted the support of a practice facilitator. Organizations reported limited use of the Toolkit in its entirety but found individual tools useful.Conclusions: The results point to the importance of support in implementing opioid quality improvement projects in primary care. The Toolkit and other 6BBs resources are available on the Agency for Healthcare Research and Quality website.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"29-40"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The potential impact of alternatives to opioids (ALTO) protocol on opioid reduction in the community emergency department.

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0895

Eric H Chou, Toral Bhakta, Ching-Fang Tiffany Tzeng, Andrew Shedd, Jon Wolfshohl, Alec Jessen, Yu-Lin Hsieh, Chinmay Patel, Robin K Chan, Jaydeep Shah, Dahlia Hassani

{"title":"The potential impact of alternatives to opioids (ALTO) protocol on opioid reduction in the community emergency department.","authors":"Eric H Chou, Toral Bhakta, Ching-Fang Tiffany Tzeng, Andrew Shedd, Jon Wolfshohl, Alec Jessen, Yu-Lin Hsieh, Chinmay Patel, Robin K Chan, Jaydeep Shah, Dahlia Hassani","doi":"10.5055/jom.0895","DOIUrl":"https://doi.org/10.5055/jom.0895","url":null,"abstract":"Objective: To investigate the potential impact of implementing alternatives to opioids (ALTOs) protocol in a community emergency department (ED) in North Texas. We hypothesize that the ALTO protocol is associated with decreased opioid utilization without affecting patient satisfaction to pain control and ED flow.Design: A retrospective, single-center, cohort study.Setting: An urban ED.Participants: Adult patients (age >18 years old) who received pain medications in ED during the study timeframe were included. A total of 34,251 patients were included for final analysis.Intervention: Patients receiving pain medication after the implementation of the ALTO protocol during March to August 2019 and patients during the same period from the prior year were identified as the post-protocol group and preprotocol group, respectively.Main outcome measures: The primary outcome was the change in ED opioid administration. Secondary outcomes included patient satisfaction to pain control, left without being seen (LWOBS), door-to-doctor time, and turnaround time.Results: The total opioid administration rate decreased by 59.6 percent after the implementation of the ALTO protocol. The percentage of patients that LWOBS (p = 0.003) and the average door-to-doctor time (p < 0.001) were significantly decreased in the post-protocol group. There was no significant difference in patient satisfaction to pain control (p = 0.192) and average turnaround time (p = 0.209).Conclusions: Implementation of an ALTO protocol was associated with a significant reduction of opioid administration without a negative impact on patient satisfaction regarding pain control and ED flow.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"77-89"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Introduction of oral methadone to high-risk patients with prolonged QT interval: A retrospective study.

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0828

Miho Takemura, Kazuyuki Niki, Yoshiaki Okamoto, Yoshinobu Matsuda, Takahito Omae, Makie Kohno, Kenji Ikeda, Mikiko Ueda

{"title":"Introduction of oral methadone to high-risk patients with prolonged QT interval: A retrospective study.","authors":"Miho Takemura, Kazuyuki Niki, Yoshiaki Okamoto, Yoshinobu Matsuda, Takahito Omae, Makie Kohno, Kenji Ikeda, Mikiko Ueda","doi":"10.5055/jom.0828","DOIUrl":"https://doi.org/10.5055/jom.0828","url":null,"abstract":"Objective: Methadone may cause detrimental side effects such as corrected QT (QTc) prolongation. However, methadone may be desirable in patients with advanced cancer and those with heart disease who have intractable pain. Therefore, we aimed to evaluate the safety and efficacy of initiating methadone for cancer pain in patients at high risk of methadone-induced QTc prolongation.Design: A retrospective cohort study.Setting: Single center.Patients: Sixty-four patients with cancer who started oral methadone to relieve pain and underwent 12-lead electrocardiogram monitoring at baseline and 1-2 weeks after initiation of methadone therapy from January 1, 2013, to March 31, 2022, were enrolled.Main outcome measures: The primary endpoints were the change in QTc from baseline after oral methadone therapy and the difference in methadone doses between the high- and low-risk groups for methadone-induced QTc prolongation.Results: None of the patients developed clinically significant methadone-induced QTc prolongation or any adverse events attributable to cardiotoxicity, although 32 patients (50.0 percent) had heart disease or prolonged QTc before oral methadone initiation. Moreover, the high-risk group received a lower dose of opioid analgesics prior to methadone administration. For this reason, they started with a lower methadone dose than the low-risk group.Conclusions: Even in patients with heart disease or prolonged QTc at baseline, methadone may be safely administered by initiating low-dose methadone when the dose of other opioids is low and by adjusting the concomitant medications that can interact with methadone.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"61-70"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development of a standardized protocol for buprenorphine induction in a chronic pain clinic. 为慢性疼痛诊所制定丁丙诺啡诱导标准方案。

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0916

Jaycee A Blair, Savannah G Hansen

{"title":"Development of a standardized protocol for buprenorphine induction in a chronic pain clinic.","authors":"Jaycee A Blair, Savannah G Hansen","doi":"10.5055/jom.0916","DOIUrl":"https://doi.org/10.5055/jom.0916","url":null,"abstract":"Objective: Create a standardized protocol document on how to convert patients from full opioid agonist to buprenorphine. Providing patients with the best possible chance of a seamless conversion resulting in decreased risk of failure of therapy with buprenorphine.Methods: A 10-question survey was distributed to better understand the different aspects the providers consider when converting a patient from full opioid agonist to buprenorphine. A medication use evaluation was completed utilizing a retrospective qualitative design to identify all patients who had a new prescription for any buprenorphine product from a chronic pain provider to establish patterns of current practice. This information, in conjunction with guidance from current literature and medication package inserts, was used to create a protocol for buprenorphine induction. Providers were educated on buprenorphine prior to guidance document implementation.Results: A five-page guidance document on how to convert patients from full opioid agonist to buprenorphine was created for providers within the chronic pain clinic. The document includes recommendations on which patients are candidates for buprenorphine versus those who are not. The document also provides a three-step process to successfully perform a conversion including which buprenorphine product and induction technique to utilize. Definitions of each induction technique along with examples are provided within the document. Recommendation for converting between buprenorphine patch and films are also listed within the document.Discussion: The five-page guidance document was successfully implemented in June 2024, supplying pain providers with all the knowledge necessary to convert patients comfortably, thus providing patients with the best possible chance of a seamless conversion and decreasing risk of failure of conversion to buprenorphine due to inadequate induction technique.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"17-27"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Dispensing issues and disciplinary measures during opioid agonist treatment: A viewpoint.

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0922

Arnab Datta, Siddharth Sarkar

{"title":"Dispensing issues and disciplinary measures during opioid agonist treatment: A viewpoint.","authors":"Arnab Datta, Siddharth Sarkar","doi":"10.5055/jom.0922","DOIUrl":"https://doi.org/10.5055/jom.0922","url":null,"abstract":"Opioid Use Disorder (OUD) poses a significant public health challenge globally, with an estimated 23 million opioid users in India. Opioid Agonist Therapy (OAT) stands as the cornerstone of treatment, offering potential reductions in morbidity, societal burdens, and improvements in patient quality of life. However, OAT coverage remains fairly low in India, with clinical guidelines lacking comprehensive information on implementation pragmatics. This viewpoint delves into the nuanced challenges faced by clinicians in the daily operations of OAT emphasizing disciplinary issues, practical responses, and the broader implications for treatment outcomes and public perception. The treatment provider's response is explored from different aspects like learning theory, attitude, psychodynamic interactions, and ethics. Understanding patient perspectives, including employment demands and perceptions of fairness, is crucial in tailoring responses and optimizing treatment engagement. While disciplinary measures are integral to maintaining treatment sanctity, their effectiveness must be balanced with patient autonomy and harm reduction goals. The discourse surrounding OAT disciplinary measures necessitates a multifaceted approach, integrating evidence-based practices, clinician experiences, patient rights, and administrative considerations to ensure equitable and effective treatment provision.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"5-9"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Suboptimal care and inappropriate opioid use in chronic pain: A critical analysis of two case studies and healthcare expenditure burden.

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0868

Sarah Al-Samawy, Anne Burke, Tim Semple, Jacinta Johnson

{"title":"Suboptimal care and inappropriate opioid use in chronic pain: A critical analysis of two case studies and healthcare expenditure burden.","authors":"Sarah Al-Samawy, Anne Burke, Tim Semple, Jacinta Johnson","doi":"10.5055/jom.0868","DOIUrl":"https://doi.org/10.5055/jom.0868","url":null,"abstract":"Introduction: Chronic pain is a leading cause of chronic disease in Australia, with a 2020 report indicating that one in five Australians aged over 45 experience chronic pain. The high prevalence of chronic pain accounts for significant healthcare utilization and associated costs, with the economic impact of chronic pain estimated to be AUD$139 billion in 2018.Case presentations: This paper uses two exemplar cases to demonstrate inadequacies within the current systems supporting those with chronic pain and the associated impacts these inadequacies have on patient outcomes and healthcare costs.Management and outcome: An analysis of these cases demonstrated a combined healthcare cost of AUD$312,705 throughout their inpatient admissions, with no apparent benefit to either patient's pain experience.Discussion and conclusion: These cases highlight a multitude of opportunities to improve current pain management systems and their detrimental effects on patient well-being, healthcare utilization, and associated costs. Despite massive expenditures for the management of chronic pain, patients often continue to experience ongoing pain and reduced quality of life. This indicates that the available funds could be better utilized through reallocation to support a proactive, biopsychosocial model of care for the prevention and management of chronic pain.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"91-97"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

At-risk opioid users in a managed care insured population: Identifica-tion and outreach from a medical and pharmacy claims database.

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0881

Leah Sera, Sarah Lipphardt, Julie Poling, Steve McGovern, Catherine E Cooke

{"title":"At-risk opioid users in a managed care insured population: Identifica-tion and outreach from a medical and pharmacy claims database.","authors":"Leah Sera, Sarah Lipphardt, Julie Poling, Steve McGovern, Catherine E Cooke","doi":"10.5055/jom.0881","DOIUrl":"https://doi.org/10.5055/jom.0881","url":null,"abstract":"Objective: To deploy an algorithm using medical and pharmacy claims data to identify members of a managed care organization at risk for opioid misuse and provide outreach.Methods: A retrospective review of 2019 enrollment information and prescription and medical claims data identified members aged 18-64 years with medical and pharmacy benefits and at least one paid pharmacy claim for an opioid. The most recent paid prescription claim served as the index date for each patient. Members with cancer or sickle cell disorder, receiving palliative/hospice care, or nursing home residents were excluded. Diagnoses were obtained for 12 months prior to the index date, while medication use was assessed within 6 months prior to the index date. Clinical characteristics were used to stratify members by risk of opioid misuse into risk-based cohorts.Results: There were 62,986 adult members with medical and pharmacy benefits receiving at least one scheduled (II, III, or IV) opioid during 2019. In this group, the average age was 43.3 years (±13.0), with 56 percent being female. More frequent diagnoses included low back pain (13.2 percent) and anxiety disorder (12.4 percent). About 10.3 percent of the group (n = 6,486 members) were assigned to one or more at-risk cohorts. Out of a total outreach attempt for 804 members, 45 percent had successful engagement. Of those members engaged, 39.8 percent declined any support services offered.Conclusion: An evidence-based algorithm found 10.3 percent of members at higher risk of opioid misuse. Interventions for targeted members reached fewer than half, and many declined assistance. Health plans need more effective intervention strategies.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"71-76"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Understanding post-operative opioid use across multiple surgical specialties. 了解多个外科专科术后阿片类药物的使用情况。

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0826

R Wesley Vosburg, Kortney A Robinson

{"title":"Understanding post-operative opioid use across multiple surgical specialties.","authors":"R Wesley Vosburg, Kortney A Robinson","doi":"10.5055/jom.0826","DOIUrl":"https://doi.org/10.5055/jom.0826","url":null,"abstract":"Background: The United States (US) is facing an opioid epidemic. Prescribed opioids are a contributor to this national issue. Strategies to reduce opioid prescriptions are a high priority. This study was designed to generate patient-level data on opioid use after surgery across different surgical specialties. We showed these data to surgeons and evaluated the impact it would have on their practice.Methods: A cross-sectional survey-based study was performed in a teaching community hospital in the US. Adult patients who underwent an operation by a member of the Department of Surgery and the surgeons who performed these operations were surveyed. Patient-level data were obtained on opioid use after surgery. The number of opioid tablets taken and days on opioids were recorded. Patients were assessed for the frequency of recovery from surgery without opioids. Additionally, information on prescriptions filled and unused opioid disposal was collected. These data were presented to surgeons who responded on how having access to it may change their future prescribing habits.Results: Opioid consumption after surgery was found to be far below expert panel guidelines across surgical specialties. Orthopedic surgery was found to be associated with significantly higher opioid use in the post-operative period. The small number of surgeons who responded showed that a large percentage planned to change opioid prescribing habits after gaining access to these data.Conclusions: This project contributes to the growing body of literature showing lower than expected opioid usage for patients after surgery. Previous trends were mostly generated from large academic centers, and this community hospital data show consistent findings of patients being left with significant quantities of unused opioids routinely after surgery. It highlights the need for evidence-based prescribing recommendations as well as the need for better education and access to opioid disposal for patients.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"41-59"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pharmaceutical Automated Reporting: An opioid stewardship tool.

Journal of opioid management Pub Date : 2025-01-01 DOI: 10.5055/jom.0926

Dylan Turner, Paul Gottselig, Leland Sommer, Kelsey Dumont, Warren Berry, Casey Phillips

{"title":"Pharmaceutical Automated Reporting: An opioid stewardship tool.","authors":"Dylan Turner, Paul Gottselig, Leland Sommer, Kelsey Dumont, Warren Berry, Casey Phillips","doi":"10.5055/jom.0926","DOIUrl":"https://doi.org/10.5055/jom.0926","url":null,"abstract":"Objective: To develop and implement a customized clinical decision support system (CDSS) in an under-resourced health region aimed at promoting appropriate and safe opioid prescribing.Design: The Pharmaceutical Automated Reporting (PAR) tool integrates inpatient prescription data from BDM Pharmacy (version 10) and categorizes patient information using predefined logic. It operates with Python (version 3.10) and Microsoft Excel®, functioning as decision trees. Nine risk factors (absence of naloxone prescription with an opioid prescription, naloxone administration, high-frequency opioid dosing, multiple opioids prescribed, concurrent benzodiazepine and opioid coprescribed, over 7 days of intravenous route opioid use, morphine equivalent dose received over or equal to 90, possible opioid agonist therapy, possible alcohol withdrawal therapy) are assessed through a decision matrix to classify patients for opioid-related risk.Results: Over 7 months, the PAR tool detected one opioid-related risk factor in 98.9 percent (n = 10,450) of patients prescribed an opioid and multiple risk factors in 62.4 percent (n = 6,590). The tool identified areas where data-driven interventions by the Opioid Stewardship Program could promote appropriate prescribing practices and will be used to track and promote stewardship interventions, inform policy change, and evaluate the impact on quality indicators.Conclusion: Small, resource-scarce health systems can use open-source programming methodologies to create an internal CDSS to assist in addressing opioid-related risk factors within their healthcare facilities.","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"21 1","pages":"11-15"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pharmacist-initiated naloxone discharge prescribing for high-risk hospitalized internal medicine patients. 药师发起的纳洛酮出院处方高危住院内科患者。

Journal of opioid management Pub Date : 2024-11-01 DOI: 10.5055/jom.0887

Michaela Elise Wermers, Ashley Weisensel Sturm, Sarah Aileen Mancini, Breann Mary Hogan

引用次数: 0