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Victoria Blaga, Aneesha Kalur, Kanika Seth, Amogh Iyer, Carolina Carvalho Soares Valentim, Rishi P Singh; Opioid Utilization in Ophthalmology and the Impact of a Decision Support Tool in Reducing Excess Dosing. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1065 – A0160.
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© ARVO (1962-2015); The Authors (2016-present)
The opioid epidemic remains a public health concern in the United States. This study investigated current opioid dosage rates in ophthalmology based on patient demographics and diagnosis and quantified the effect of an opioid alert system on prescription practices in this retrospective, pre and post implementation study.
A retrospective chart review was conducted of opioid prescriptions written by ophthalmologists between January 3, 2015, and November 3, 2021. An opioid alert system was implemented in December 2017. The study population was divided into three cohorts based on when an individual’s prescription was written: prior to system implementation (cohort 1), while the system was active, but not recorded in the EHR (cohort 2), or while the system was both active and recorded in the EHR (cohort 3). Dosage was measured in morphine equivalent daily dose (MEDD). Mean MEDD per prescription and mean number of prescriptions per patient were compared based on patient demographics, diagnosis, and cohort. For statistical analysis, independent t-tests and linear mixed effects models were completed.
8014 individuals were included in this study with 4388, 2276, and 1350 individuals in cohorts 1, 2, and 3 respectively. The majority of individuals were female (59.26%) and white (82.31%). There was no significant difference in mean MEDD based on patient demographics when comparing cohorts. However, when considering all cohorts together, black individuals received the highest mean MEDD (33.93 MEDD, p = 0.03 compared to white individuals) and male individuals received a higher mean MEDD when compared to females (33.53 MEDD; p < 0.001). While not statistically significant, glaucoma was the diagnosis category with the highest mean MEDD per prescription (34.94 MEDD). Mean MEDD per prescription decreased by 15.44 between cohorts 1 and 3 (p < 0.001) after implementation of the electronic alert system.
This study demonstrates significant differences in opioid prescription dosage based on patient demographics. The observed decrease in opioid prescription dosage following the alert system may indicate system realization. Patient demographics provide foci for opioid prescription reform in ophthalmology however significant differences between patient diagnosis were not demonstrated.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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