PDF(Pubmed)
Abstract：
Opioid prescribing and dispensing from emergency departments is a noteworthy issue given widespread opioid misuse and diversion in many countries, contributing both physical and economic harm to the population. High patient numbers and the stochastic nature of acute emergency presentations to emergency departments (EDs) introduce challenges for prescribers who are considering opioid stewardship principles. This study investigated the effect of changes to electronic prescribing software on prescriptions with an auto-populated quantity of oxycodone immediate release (IR) from an Australian tertiary emergency department following the implementation of national recommendations for reduced pack sizes. A retrospective review of oxycodone IR prescriptions over two six-month periods between 2019 and 2021 was undertaken, either side of a software adjustment to reduce the default quantities of tablets prescribed from 20 to 10. Patient demographic details were collected, and prescriber years of practice calculated for inclusion in linear mixed effects regression modelling. A reduction in the median number of tablets prescribed per prescription following the software changes (13.5 to 10.0, p < 0.001) with little change in the underlying characteristics of the patient or prescriber populations was observed, as well as an 11.65% reduction in the total number of tablets prescribed. The prescriber\'s years of practice, patient age and patient sex were found to influence increased prescription sizes. Reduced quantity of oxycodone tablets prescribed was achieved by alteration of prescribing software prefill parameters, providing further evidence to support systems-based policy interventions to influence health care providers behaviour and to act as a forcing function for prescribers to consider opioid stewardship principles.
摘要：
鉴于阿片类药物在许多国家普遍滥用和转移，急诊科的阿片类药物处方和配药是一个值得注意的问题。对人口造成身体和经济伤害。高患者人数和急诊部门（ED）的急性急诊报告的随机性给正在考虑阿片类药物管理原则的处方者带来了挑战。这项研究调查了在实施国家减少包装尺寸的建议后，电子处方软件的更改对澳大利亚三级急诊科自动填充量的羟考酮立即释放（IR）的处方的影响。在2019年至2021年的两个六个月期间，对羟考酮IR处方进行了回顾性审查，软件调整的任一侧，以将处方的片剂的默认数量从20减少到10。收集患者的人口统计细节，并计算出处方年的实践，以纳入线性混合效应回归模型。软件更改后，每个处方的处方片剂数量减少（13.5至10.0，p<0.001），患者或处方人群的基本特征几乎没有变化，以及处方片剂总数减少11.65%。处方者多年的实践，研究发现,患者年龄和患者性别会影响处方量的增加.通过改变处方软件预充参数，可以减少处方羟考酮片剂的数量。提供进一步的证据来支持基于系统的政策干预,以影响卫生保健提供者的行为,并作为处方者考虑阿片类药物管理原则的强制功能.
