Files and links (2)
CC BY-NC-ND V4.0, Open Access
Journal article
A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits
The Journal of emergency medicine, Vol.51(5), pp.498-507
11/2016
Handle:
https://hdl.handle.net/2376/102900
PMID: 27624507
Abstract
Increasing prescription overdose deaths have demonstrated the need for safer emergency department (ED) prescribing practices for patients who are frequent ED users.
We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients.
We conducted a multisite randomized controlled trial (RCT) across all EDs in a metropolitan area; 165 patients with the most ED visits for complaints of pain were randomized. For the treatment arm, drivers of ED use were identified by medical record review. Patients and their primary care providers were contacted by phone. Each patient was discussed at a community multidisciplinary meeting where recommendations for ED care were formed. The ED care recommendations were stored in an ED information exchange system that faxed them to the treating ED provider when the patient presented to the ED. The control arm was subjected to treatment as usual.
The intervention arm experienced a 34% decrease (incident rate ratios = 0.66, p < 0.001; 95% confidence interval 0.57–0.78) in ED visits and an 80% decrease (odds ratio = 0.21, p = 0.001) in the odds of receiving an opioid prescription from the ED relative to the control group. Declines of 43.7%, 53.1%, 52.9%, and 53.1% were observed in the treatment group for morphine milligram equivalents, controlled substance pills, prescriptions, and prescribers, respectively.
This RCT showed the effectiveness of a citywide ED care coordination program in reducing ED visits and controlled substance prescribing.
Metrics
19 Record Views
Details
- Title
- A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits
- Creators
- Darin Neven - Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, WashingtonLeonard Paulozzi - National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GeorgiaDonelle Howell - Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, WashingtonSterling McPherson - Elson S. Floyd College of Medicine, Washington State University, Spokane, WashingtonSean M Murphy - Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, WashingtonBecky Grohs - Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, WashingtonLinda Marsh - Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WashingtonCrystal Lederhos - Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, WashingtonJohn Roll - Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington
- Publication Details
- The Journal of emergency medicine, Vol.51(5), pp.498-507
- Academic Unit
- Medical Education and Clinical Science, Department of; Elson S. Floyd College of Medicine; Health Policy and Administration, Department of
- Publisher
- Elsevier Inc
- Number of pages
- 10
- Identifiers
- 99900546560601842
- Language
- English
- Resource Type
- Journal article