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Tytuł:
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Nudging patients and surgeons to change ambulatory surgery pain management: Results from an opioid buyback program.
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Autorzy:
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Liu JY; VA Medical Center, White River Junction, VT; The Geisel School of Medicine at Dartmouth College, Hanover, NH. Electronic address: .
Anderson JC; VA Medical Center, White River Junction, VT; The Geisel School of Medicine at Dartmouth College, Hanover, NH; University of Connecticut School of Medicine, Farmington, CT.
Franklin JS; VA Medical Center, White River Junction, VT; The Geisel School of Medicine at Dartmouth College, Hanover, NH. Electronic address: https://twitter.com/JulieFr87732501.
Gesek FA; VA Medical Center, White River Junction, VT. Electronic address: https://twitter.com/FrankGesek.
Soybel DI; VA Medical Center, White River Junction, VT; The Geisel School of Medicine at Dartmouth College, Hanover, NH. Electronic address: https://twitter.com/DSoybel.
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Źródło:
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Surgery [Surgery] 2021 Aug; Vol. 170 (2), pp. 485-492. Date of Electronic Publication: 2021 Mar 04.
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Typ publikacji:
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Journal Article; Research Support, U.S. Gov't, Non-P.H.S.
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Język:
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English
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Imprint Name(s):
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Publication: St. Louis, MO : Mosby
Original Publication: St. Louis.
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MeSH Terms:
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Motivation*
Practice Patterns, Physicians'*
Prescription Drug Monitoring Programs*
Ambulatory Surgical Procedures/*adverse effects
Analgesics, Opioid/*therapeutic use
Pain, Postoperative/*drug therapy
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Pain Management ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology ; Prospective Studies
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Substance Nomenclature:
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0 (Analgesics, Opioid)
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Entry Date(s):
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Date Created: 20210307 Date Completed: 20210908 Latest Revision: 20210908
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Update Code:
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20240104
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DOI:
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10.1016/j.surg.2021.01.016
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PMID:
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33676733
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Background: Optimal postoperative opioid stewardship combines adequate pain medication to control expected discomfort while avoiding abuse and community diversion of unused prescribed opioids. We hypothesized that an opioid buyback program would motivate patients to return unused opioids, and surgeons will use that data to calibrate prescribing.
Methods: Prospective cohort study of postambulatory surgery pain management at a level II Veterans Affairs rural hospital (2017-2019). Eligible patients were offered $5/unused opioid pill ($50 limit) returned to our Veterans Affairs hospital for proper disposal. After 6 months, buyback data was shared with each surgical specialty.
Results: Overall, 934 of 1,880 (49.7%) eligible ambulatory surgery patients were prescribed opioids and invited to participate in the opioid buyback. We had 281 patients (30%) return 3,165 unused opioid pills; this return rate remained constant over the study period. In 2017, 62.4% of patients were prescribed an opioid; after data was shared with providers, prescriptions for opioids were reduced to 50.7% and 38.3% of eligible patients in 2018 and 2019, respectively (P < .0001). The median morphine milligram equivalents prescribed also decreased from 108.8 morphine milligram equivalents in 2017 to 75.0 morphine milligram equivalents in 2018 and sustained at 75.0 morphine milligram equivalents in 2019 (P < .001). Surgical providers, surgeries performed, patient characteristics, and 30-day refill rates were similar throughout the study period.
Conclusion: A small financial incentive resulted in patients returning unused opioids after ambulatory surgery. Feedback to surgeons regarding opioids returned reduced the proportion of patients prescribed an opioid and the amount of opioid after ambulatory surgery without an increase in refills.
(Published by Elsevier Inc.)
