Short Attention Span Summary
Busted - watch out drug seekers in Spokane.
This city's EDs banded together to coordinate care for some of the most frequent ED utilizers for pain complaints. 165 high frequency users were randomized to usual care or city-wide care coordination. If a patient was in the intervention group, the ED doctor on call received a fax notification with that person's individualized plan of care each time they presented to the ED. There was a 34% drop in ED visits and 80% decrease in the odds of getting an opiate prescription in the intervention group.
A city-wide plan of care for frequent ED users for pain-related complaints decreased the number of visits and opiate prescriptions.
J Emerg Med. 2016 Nov;51(5):498-507. doi: 10.1016/j.jemermed.2016.06.057. Epub 2016 Sep 10.
1Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington; Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.
2National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
3Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington.
4Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.
5Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington; Department of Health Policy and Administration, Washington State University College of Nursing, Spokane, Washington.
6Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington.
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.
Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.
PMID: 27624507 [PubMed - in process]