After more than 1,000 orthopedic procedures at a home health system, about 61 percent of opioids prescribed to patients went unused, according to a new study.
This was found within a study at the Perelman School of Medicine in the University of Pennsylvania that showed that the majority of patients responded to text messages designed to measure patient use of their medications.
The fact that so many patients are comfortable texting this information to their care teams is known to be extremely helpful as medical professionals look at proper pain medication prescriptions and reduce the number of opioids prescribed. may be misused when left. This study was published in Catalist NEJM.
This approach is a step towards building a dynamic and growing learning health system to treat patients. We know that opioid epilepsy has hit the country in many ways. One of the key areas to address is reducing the amount of opioid pills left in the community that pose a risk to individuals, families and children. “
Anish Agarwal, MD, Lead study author and Associate Professor of Emergency Medicine, University of Pennsylvania
Clinicians know that a balance needs to be struck between pain management and opioid pain medications, but there is little with patient data to guide them. Opioid intake amounts have largely been the best estimates based on clinician training or a rough estimate using patients ’medical history.
Agarwal, senior author of M. Kit Delgado, MD, co-chair of the Penn Medicine Opioid Action Group and assistant professor of Emergency Medicine, and their colleagues wanted to refine these estimates and guide the issue of procedural change. .
To do so, they sought a way to deliver real-time statistics on what pain medication patients are using. The system they developed was based on automated chat text messaging.
Patients were advised to enter the automated system by their clinical team, they would receive text messages being entered into the program on the fourth day after their procedure.
If the patient responded that they would like to participate, the automated system encouraged simple text conversation. He asked questions about things like patients’ pain levels, their ability to manage their pain, and the use of their prescription opioids.
These messages were set to go out on the fourth, seventh, fourteenth, and thirty-one days after their procedures. If at any time patients indicated that they were no longer taking the opioid pain medication, the messages stopped.
The research team reached out to approximately 2,400 patients of orthopedic procedures between September 2018 and January 2020.
Almost half agreed to take part in the program, which, in itself, was an important finding for the researchers as it showed widespread willingness to use this type of system. In addition, the researchers found a high rate of responses among these patients with 88 percent responding on the fourth postoperative day.
The lowest level of responses was observed on the seventh day of patients (at 69 percent). For those patients who used medications on day 21, 95 percent responded.
Overall, patients reported a reduction in their pain levels across all procedures. But this seemed to be accomplished without most of the opioids prescribed.
More than 1,100 patients participated in the testing system, and from that population, the researchers found that more than 10,000 opioid tablets were left unused, about 61 percent of those prescribed.
While research on the subject is narrow, that is within the range, albeit at its peak, of what is thought to be the average amount of opioids left over from medical procedures.
Agarwal believes that setting up a system like this – which patients would pick up at high rates – provides a real-time, patient-based feedback system that can be developed. used to alter opioid drug levels and reduce the chance of them becoming potentially lethal pills that could be misused.
“Our system acts as a quality improvement tool and as a way for providers to see trends in patient-reported pain and opioid use after their surgeries,” Agarwal said. analyze, and provide information about future prescribing to predict and meet the ongoing needs of our patients. “
One of the goals of the team studying this texting system is to identify what levels of opioids would be required for each type of procedure. For example, routine prescribing practices may go beyond the pain management needs of a shoulder surgery patient, but are largely correct for someone undergoing hip replacement.
“As orthopedic surgeons, we are always concerned that we will not provide enough medication to care for our patients’ postoperative pain. In the past, it was actually an approximate measure that ‘error on the side of not subscribing,” explained study co-author Brian Sennett, MD, head of Sports Medicine and associate professor of orthopedic surgery at Penn Medicine.
“Our goal is to treat our patients well as long as they don’t over-write. In the future, I’m excited about sharing this data with our patients and be involved in their postoperative pain management, which I believe will bring the next major reduction in opioid prescribing. “
Although this study used orthopedic surgeries to test the system, Agarwal said it opens the door for pain management ideas across many departments.
“This is the beginning of a lot of exciting work with the support of many Departments, the University, and the FDA,” Agarwal said.
Source:
University of Pennsylvania School of Medicine