EHRs can nudge docs toward prescribing fewer opioids, study finds
A new study in the Journal of General Internal Medicine found that adding a default setting to EHRs can limit opioid prescriptions given by emergency department physicians.
The University of Pennsylvania School of Medicine study said adding a default can increase compliance with opioid prescribing guidelines for acute pain.
This comes as payers, health systems, providers and federal leaders are all exploring ways to decrease opioid abuse.
Overprescribing opioids, especially to patients new to the drug, can lead to addiction and misuse. The CDC found that 6% of people who receive a one-day supply of opioids for acute pain still take opioids a year later. That increases to 13.5% for people getting a prescription for eight days or more and to 30% for those prescribed 30 days or more.
The opioid crisis isn't just a public health issue. A recent report from the White House Council of Economic Advisers said the cost of the opioid crisis in 2015 totaled $504 billion (2.8% of GDP) and more than 33,000 Americans died of an opioid-related drug overdose.
For the study, two Penn Medicine EDs created a default option, which pushed physicians into prescribing fewer tablets. The researchers found the default of 10 tablets resulted in fewer opioids prescribed to patients. Initial prescriptions of 10 tablets increased from 22% to 43%. Physicians were able to opt-out of the 10-tablet prescription, but the study showed fewer physicians overrode the default.
Prescriptions of 20 tablets decreased by 7% and prescriptions of between 11 and 19 tablets decreased by 13%. On the flip side, the study showed the default prescription amount also unintentionally decreased the percentage of opioid prescriptions of fewer than 10 tablets.
Lead author Dr. M. Kit Delgado, an assistant professor of Emergency Medicine and Epidemiology at the Perelman School of Medicine at the University of Pennsylvania, said the results show a promising, scalable approach to reduce opioid abuse.
“We know that prescribing too many opioid tablets for acute pain increases a patient's risk for long-term use or the potential to be abused if left in the medicine cabinet, so making it easier to prescribe quantities consistent with current guidelines while still keeping physician autonomy is an important part of addressing the opioid crisis we're facing in this country,” said Delgado.
The study’s positive results are unlike other initiatives aimed at tackling opioids. A recent New England Journal of Medicine (NEJM) paper found that opioid programs that targeted doctors have not worked. Limiting the supply of opioids dispensed at a time also brought about no meaningful effect, according to the NEJM report.
Nevertheless, the Penn Medicine default idea is one possible way to reduce opioid abuse, which will likely interest multiple healthcare stakeholders, including payers, providers, pharmacists and health systems, which are looking for ways to reverse the trend.
America’s Health Insurance Plans (AHIP) recently launched a program called the Safe, Transparent Opioid Prescribing (STOP) Initiative. In the program, payers collaborate with state and federal leaders, physicians and other providers on ways to address the crisis. The STOP Initiative also supports adoption of clinical guidelines for pain care and opioid prescribing.
Also, the Pharmaceutical Research and Manufacturers of America recently offered a policy that included limiting the supply of opioid medications to seven days for acute pain, as well as offering other initiatives that PhRMA believes will help.
At the individual payer level, Aetna, which has five-year goals to reduce opioid usage and misuse by 2022, recently launched a new program that waives the co-pay for Narcan for fully insured members. The payer also ended pre-authorization requirements for buprenorphine products, drugs used to help people get off opioids, for commercial members.
Others healthcare companies have their own efforts. Anthem recently reached its goal of reducing filled opioid prescriptions by 30%, Cigna achieved a 12% reduction in customer opioid use and Intermountain Health set a goal of reducing opioid prescriptions 40% by the end of 2018.
While healthcare stakeholders target the issue, there have been mixed messages from the White House. President Donald Trump declared the opioid epidemic a public health emergency last year, but the president didn't attach any money to the effort. Also, the administration is looking to cut the Office of National Drug Control Policy by 95%, which is working on the opioid crisis. The cut would include moving two grant drug-prevention programs to the Department of Justice and HHS, according to Politico.