Appl Clin Inform 2023; 14(05): 961-972
DOI: 10.1055/s-0043-1776879
Research Article

Opioid Prescribing for Chronic Musculoskeletal Conditions: Trends over Time and Implementation of Safe Opioid-Prescribing Practices

Meghan K. Wally
1   Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, United States
2   Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States
,
Michael E. Thompson
2   Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States
,
Susan Odum
1   Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, United States
2   Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States
,
Donna M. Kazemi
3   School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, United States
,
Joseph R. Hsu
1   Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, United States
,
Rachel B. Seymour
1   Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, United States
,
and PRIMUM Group › Author Affiliations
Funding This work was supported in part by a cooperative agreement (CE14-004 Award Number CE002520) from the CDC and an internal grant from the Carolinas Trauma Network Research Center of Excellence. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.
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Abstract

Objectives This study aimed (1) to determine the impact of a clinical decision support (CDS) tool on rate of opioid prescribing and opioid dose for patients with chronic musculoskeletal conditions and (2) to identify prescriber and facility characteristics associated with adherence to the Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain in this population.

We conducted an interrupted time series analysis to assess trends in percentage of patients from 2016 to 2020, receiving an opioid and the average opioid dose, as well as the change associated with implementation of the CDS toolkit. We conducted a retrospective cohort study to assess the association between prescriber and facility characteristics and safe opioid-prescribing practices.

Methods We assessed the impact of the CDS intervention on percent of patients receiving an opioid and average opioid dose (morphine milligram equivalents). We operationalized safe opioid prescribing as a composite score of several behaviors (i.e., prescribing naloxone, initiating a pain agreement, prescribing <90 MME, avoiding extended-release prescriptions for opioid-naïve patients, and avoiding coprescribing opioids and benzodiazepines) and used a hierarchical linear regression model to assess associations between prescriber and facility characteristics and safe opioid prescribing.

Results This CDS intervention had a modest but statistically significant 1.6% reduction on the percent of patients (n = 1,290,746) receiving an opioid (mean: 15% preintervention; 10% postintervention). The average dose of opioid prescriptions did not significantly change. Advanced practice providers and prescribers with higher percentages of patients aged 18 to 64 exhibited safer opioid prescribing, while prescribers with higher percentages of white patients and larger numbers of patients on opioids exhibited less safe opioid prescribing.

Conclusion A CDS intervention was associated with a small improvement in percent of patients receiving an opioid, but not on average dose. Clinicians are not prescribing opioids for chronic musculoskeletal conditions frequently, when they do, they are generally adhering to guidelines.

Protection of Human and Animal Subjects

This project was approved by the Atrium Health IRB (12–14–04E) and the Wake Forest University School of Medicine IRB (IRB-M-21–0402).


* PRIMUM GROUP: Michael Beuhler, MD4; Michael Bosse, MD1; Michael Gibbs, MD5; Christopher Griggs, MD5; Steven Jarrett, PharmD6; Daniel Leas, MD1,7; Tamar Roomian, MS, MPH1; Michael Runyon, MD5; Animita Saha, MD8; Brad Watling, MD9; Ziqing Yu, MS.1


Supplementary Material



Publication History

Received: 10 May 2023

Accepted: 09 October 2023

Article published online:
06 December 2023

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