The implementation of an obligatory prescription drug tracking program caused a right away lower in postoperative opioid prescriptions in 3 surgical specialties, consistent with findings posted in JAMA Health Forum. Specifically, opioids have been prescribed much less to sufferers who underwent general, obstetric/gynecologic, or orthopedic surgical treatment. “We estimated that the Controlled Utilization Review and Evaluation System (CURES) mandate was associated with more than 100,000 fewer opioid tablets in circulation after five quarters of CURES mandate implementation in [one] fitness care system alone,” Rivfka Shenoy, MD, MS, a fashionable surgical treatment resident in the David Geffen School of Medicine on the University of California, Los Angeles, and co-workers wrote. In July 2016, California exceeded rules mandating using CURES in reaction to the opioid epidemic. The mandate become applied on Oct. 2, 2018, consistent with the researchers. It calls for physicians to seek advice from CURES earlier than they are able to prescribe a managed substance. The software additionally integrates digital health report indicators which can be related to modifications in the number of opioid medications prescribed after surgical treatment. Physicians can pass the CURES session in the event that they prescribe a five-day or supply of postoperative opioid prescriptions.

To verify the effect of CURES, Shenoy and co-workers carried out a cross-sectional take a look at opioid prescribing styles in the health care system of Sutter Health in Northern California among Jan. 1, 2015, and Feb. 1, 2020. They used digital health record data to observe opioid prescribing traits amongst 93,760 sufferers who underwent fashionable, obstetric/gynecologic or orthopedic surgical treatment. The sufferers’ imply age becomes 46.7 years; 67.9% have been women. Among the study cohort, opioids have been prescribed to 65,911 sufferers earlier than the mandate and 27,849 sufferers after implementation. Before CURES, the Sutter Health system become already experienced a lower in opioid prescribing, consistent with Shenoy and co-workers. During the preliminary length of the program, overall morphine milligram equivalents (MMEs) at discharge further reduced via way of means of 5.3% in fashionable surgical treatment, 12.2% in obstetric/gynecologic surgery, and 9.6% in orthopedic surgical treatment, as did the overall quantity of capsules in every specialty by 10.5%, 15.7%, and 9.2%, respectively. However, reductions in opioid prescriptions have been inconsistent in common surgeries. For example, overall capsules prescribed for patients who underwent a cesarean transport were reduced to begin with whilst the median MMEs did not. Moreover, neither pill totals nor MMEs were reduced for patients who underwent knee arthroscopies. Overall, the share of prescriptions for longer than five days reduced drastically for the duration of preliminary implementation throughout the 3 unique surgical specialties. The mean MMEs prescribed earlier than and after the CURES mandate have been 198.2 vs. 123.1 for fashionable surgical treatment, 189 vs. 137.2 for obstetric/gynecologic surgical treatment, and 360. 9 vs. 259.7 for orthopedic surgical treatment. Also, the common overall quantity of tablets prescribed earlier than and after the CURES mandate was 32.6 vs. 20.8 for fashionable surgical treatment, 31.9 vs. 21.4 for obstetric/gynecologic surgical treatment, and 48.0 vs. 36.3 for orthopedic surgery.

While the mandated program may also have “substantial implications for reducing the number of opioid tablets statewide the implementation of an [electronic health record] alert to prompt adherence to the CURES mandate introduced a disruption to physician workflow at the health care system examined,” Shenoy and co-workers wrote.

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