TY - JOUR
T1 - The effectiveness of stewardship interventions to reduce the prescribing of extended-release opioids for acute pain
T2 - A systematic review
AU - Awadalla, Rebecca
AU - Gnjidic, Danijela
AU - Patanwala, Asad
AU - Sakiris, Marissa
AU - Penm, Jonathan
N1 - Funding Information:
Funding sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. DG is supported by the National Health and Medical Research Council Dementia Leadership Fellowship.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020
Y1 - 2020
N2 - Objective. To evaluate the effectiveness of stewardship interventions in reducing the prescribing of extended-release opioids for acute pain. Design. Systematic review of randomized controlled trials, pre-post intervention studies, cohort studies and case-control studies. Methods. A search was conducted using Medline, Scopus, Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts, and PsycINFO from inception to March 24, 2019. Search terms included opioids, interventions, extended-release, and acute pain. Included articles were original research articles outlining the impact of stewardship interventions on reducing the prescribing of extended-release opioids for acute pain. Results. The search resulted in 1,264 articles after the removal of duplicates. Of these, 141 full texts were assessed, with three eligible for inclusion. One additional article was obtained via a manual search. Three studies explored forcing function interventions; two included prior authorization policies, which saw decreases in extended-release/long-acting scripts by 18-36%, while another evaluated order restrictions producing increased adherence to guidelines by 36%. One study explored the impact of education targeting prescribers and patients through a risk mitigation and evaluation strategy, which decreased extended-release/long-acting quarterly script volumes by 4.3%. All studies were performed at system levels. Forcing function interventions decreased extendedrelease/ long-acting prescriptions and increased adherence to guidelines to a greater extent than less restrictive interventions such as education. Conclusions. Forcing function interventions implemented at system levels show promise in decreasing the prescribing of extended-release opioids for acute pain. The current lack of literature warrants future research to increase understanding of the effectiveness of such interventions.
AB - Objective. To evaluate the effectiveness of stewardship interventions in reducing the prescribing of extended-release opioids for acute pain. Design. Systematic review of randomized controlled trials, pre-post intervention studies, cohort studies and case-control studies. Methods. A search was conducted using Medline, Scopus, Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts, and PsycINFO from inception to March 24, 2019. Search terms included opioids, interventions, extended-release, and acute pain. Included articles were original research articles outlining the impact of stewardship interventions on reducing the prescribing of extended-release opioids for acute pain. Results. The search resulted in 1,264 articles after the removal of duplicates. Of these, 141 full texts were assessed, with three eligible for inclusion. One additional article was obtained via a manual search. Three studies explored forcing function interventions; two included prior authorization policies, which saw decreases in extended-release/long-acting scripts by 18-36%, while another evaluated order restrictions producing increased adherence to guidelines by 36%. One study explored the impact of education targeting prescribers and patients through a risk mitigation and evaluation strategy, which decreased extended-release/long-acting quarterly script volumes by 4.3%. All studies were performed at system levels. Forcing function interventions decreased extendedrelease/ long-acting prescriptions and increased adherence to guidelines to a greater extent than less restrictive interventions such as education. Conclusions. Forcing function interventions implemented at system levels show promise in decreasing the prescribing of extended-release opioids for acute pain. The current lack of literature warrants future research to increase understanding of the effectiveness of such interventions.
KW - Acute pain
KW - Extended-release
KW - Interventions
KW - Opioids
UR - http://www.scopus.com/inward/record.url?scp=85094933362&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85094933362&partnerID=8YFLogxK
U2 - 10.1093/PM/PNAA139
DO - 10.1093/PM/PNAA139
M3 - Review article
C2 - 32488237
AN - SCOPUS:85094933362
SN - 1526-2375
VL - 21
SP - 2401
EP - 2411
JO - Pain Medicine (United States)
JF - Pain Medicine (United States)
IS - 10
ER -