Christiana Care, Delaware’s largest health care provider hassharply cut the dispensing of opioids.
The system announced this week it has reduced the use of opioids systemwide, including in post-surgical prescribing, its emergency departments and in primary care. Resultsinclude:
- A 40 percent reduction in the number of opioids prescribed after some ob-gyn and general surgery procedures.
- A reduction by almost 50 percent in the rate of opioid prescriptions among discharged emergency department patients.
- A 37 percent reduction in primary care patients on chronic opioid therapy for pain in a pilot project.
In 2012, Delaware was the nation’s No. 1 prescriber of high-dose opioid pain relievers and 17th in opioid prescriptions overall. By 2016, Delaware saw on average a death a day from an opioid overdose.
A multifaceted strategy
“We’ve embarked on a multifaceted strategy to educate providers about responsible prescribing practices, promote non-opioid alternatives to control pain and spread evidence-based guidelines around opioid prescription,” said Linda Lang, M.D., chair of Christiana Care’s Safe Opioid Stewardship Steering Committee. Lang also chairs the Department of Psychiatry.
The goalof Christiana Care’s efforts is to reduce chronic opioid use, combat addiction and, reduce overdose deaths. A release noted that primary care offices are the single largest source of opioid prescriptions.
Christiana Care is putting non-opioid alternatives front-and-center in patients’ electronic medical record, educating providers about alternatives to pain and identifying patients on long-term opioid use at the highest risk, said Roger Kerzner, M.D.. He is director for specialty services at the Medical Group of Christiana Care.
There is some evidence that a team approach focusing on high-risk populations can pay off, a release stated. A pilot project at the Rocco A. Abessinio Family Wilmington Health Center at Wilmington Hospital resulted in a 37 percent reduction in the number of patients on chronic opioid therapy.
Data analysis employed
Data analysis is one tool the pilot used to identify patients who are at higher risk of addiction and even accidental death from chronic opioid use due to their other medications, health conditions and other factors, said Ed Ewen, M.D., director of clinical data and analytics. Ewen is also a primary care physician at Christiana Care.
Another key focus, Kerzner said, is to try alternative approaches for patients who started using opioids in the past few months and whose use may become chronic.
Many patients are first exposed to opioids after a surgical procedure, and too many of them eventually become dependent.
Building off the work by an effort in Michigan known as the Opioid Prescribing Engagement Network, or OPEN, Christiana Care developed a set of guidelines. The guidelines recommend specific medications and quantities after 21 surgical procedures.
Accepting some level of pain
Often, prescribing fewer opioids means accepting some level of pain after a procedure. Doctors are now talking about pain in terms of function: Can the patient work, sleep and carry out other everyday tasks?
Though prescribing guidelines are optional, early data shows a 40 percent reduction in opioids.
Christiana Care’s emergency departments, too, are engaged in finding alternatives to treat acute pain.
Christiana Care’s three emergency departments are dealing with both ends of addiction by helping those with a substance use disorder gain access to treatment and keeping tabs on prescribing opioids.
The departments cut by nearly half the rate of opioid prescriptions among discharged patients, to eight percent in May 2018.
“Our repeated education of Delaware ACEP guidelines, along with initiatives like Middletown’s Opioid Alternative Environment and the Suboxone pilot, has helped us treat pain in an appropriate manner without prescribing needlessly,” said John T. Powell, M.D, chairman of the Department of Emergency Medicine at Christiana Care.
By tapping Project Engage’s peer counselors to meet with patients, the emergency departments are identifying those struggling from withdrawal.
When appropriate, the emergency department is piloting a program to start these patients on Suboxone, a medication that provides immediate relief from the symptoms of withdrawal. Also, connections are made with an all-hours treatment center that offers medication-assisted therapy and counseling.
Meanwhile, the Middletown Emergency Department is developing alternatives in an effort called the Opioid Alternative Environment. Opioids can be used, but other methods — including trigger point injections of anesthetic and, in some cases, IV acetaminophen — will be tried first.