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Evaluating the Impact of a Clinical Decision Support Tool to Reduce Chronic Opioid Dose and Decrease Risk

Shardool Patel1, Jan M Carmichael1, Janice M Taylor1

  • 11 VHA Sierra Pacific Network (VISN 21), Reno, NV, USA.

The Annals of Pharmacotherapy
|November 1, 2017
PubMed
Summary

Completing the Chronic Opioid Therapy-Clinical Reminder (COT-CR) tool significantly reduced morphine equivalent monthly dose (MEMD) and overdose risk scores in veterans. This highlights the effectiveness of active monitoring in improving opioid prescribing practices and patient safety.

Keywords:
analgesicsclinical decision makingnarcoticsoutcomesoutcomes research/analysispain management

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Area of Science:

  • Clinical Informatics
  • Pharmacology
  • Public Health

Background:

  • Chronic opioid therapy-clinical reminder (COT-CR) is a decision support tool designed to mitigate risks associated with long-term opioid prescribing.
  • Inappropriate opioid prescribing practices necessitate tools for careful patient assessment.

Purpose of the Study:

  • To evaluate the impact of the COT-CR tool on reducing morphine equivalent monthly dose (MEMD) and the risk index for overdose or serious prescription opioid-induced respiratory depression (RIOSORD) in veterans on chronic opioid therapy.

Main Methods:

  • A retrospective cohort study matched patients with complete COT-CR data to those with incomplete data using propensity scores.
  • An interrupted time series design analyzed MEMD changes 12 months pre- and 6 months post-COT-CR installation.
  • A secondary analysis assessed changes in RIOSORD index score and risk class.

Main Results:

  • The study included 3801 matched patients in complete and incomplete COT-CR groups.
  • Patients with complete COT-CR showed a greater average reduction in MEMD (-11.6) and RIOSORD index score (-0.53) compared to the incomplete group (P=0.032 and P=0.030, respectively).
  • No significant difference was found in RIOSORD risk class changes between groups.

Conclusions:

  • Completion of the COT-CR tool is associated with significant reductions in MEMD and RIOSORD values.
  • Active monitoring through tools like COT-CR can modify prescribing patterns, thereby lowering opioid overdose risks in veterans.