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Topics
- Ambulatory Care and Surgery (2)
- Antibiotics (2)
- Antimicrobial Stewardship (2)
- Asthma (1)
- Behavioral Health (1)
- Blood Thinners (1)
- Cardiovascular Conditions (1)
- Care Management (3)
- Children/Adolescents (1)
- Chronic Conditions (1)
- Communication (1)
- Community-Based Practice (1)
- Dental and Oral Health (1)
- Elderly (1)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Department (1)
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- Inpatient Care (1)
- (-) Medication (16)
- Medication: Safety (3)
- Opioids (9)
- Pain (1)
- Patient Safety (2)
- Practice Patterns (6)
- Prevention (1)
- Primary Care (3)
- (-) Provider (16)
- Provider: Clinician (3)
- Provider: Nurse (1)
- Provider: Pharmacist (5)
- Provider: Physician (9)
- Provider: Physician Assistant (1)
- Respiratory Conditions (1)
- Shared Decision Making (1)
- Substance Abuse (4)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedEverson J, Cheng AK, Patrick SW
Association of electronic prescribing of controlled substances with opioid prescribing rates.
The purpose of this study was to assess the association between use of electronic prescribing of controlled substances (EPCS) and trends in opioid prescribing. Results suggested that an increased use of EPCS was not associated with decreased opioid prescribing or a decrease in the amount prescribed and may have been associated with a small increase in opioid prescribing. Recommendations included levers to ensure that EPCS is integrated with outside data and that information is actively used to inform prescribing decisions.
AHRQ-funded; HS026395.
Citation: Everson J, Cheng AK, Patrick SW .
Association of electronic prescribing of controlled substances with opioid prescribing rates.
JAMA Netw Open 2020 Dec;3(12):e2027951. doi: 10.1001/jamanetworkopen.2020.27951..
Keywords: Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Opioids, Medication, Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Militello LG, Hurley RW, Cook RL
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
Investigators sought a better understanding of primary care clinicians’ approaches to managing patients with chronic pain and explored implications for technological and administrative interventions. They found that primary care clinicians’ beliefs about opioid therapy generally align with the clinical evidence but may have some important gaps, suggesting the potential value of interventions that include improved access to research findings, organizational changes to support spending time with patients to develop rapport, and the need for innovative clinical cognitive support.
AHRQ-funded; HS023306.
Citation: Militello LG, Hurley RW, Cook RL .
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
J Gen Intern Med 2020 Dec;35(12):3542-48. doi: 10.1007/s11606-020-06178-2..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Provider: Physician, Provider: Clinician, Provider, Care Management
Alley L, Novak K, Havlin T
Development and pilot of a prescription drug monitoring program and communication intervention for pharmacists
The authors developed the Resources Encouraging Safe Prescription Opioid and Naloxone Dispensing (RESPOND) Toolkit to enhance community pharmacists' understanding of their role in addressing opioid safety; to improve integration of prescription drug monitoring program (PDMP) into daily workflow; and to enhance communication between pharmacists, prescribers, and patients. In this paper, they described the development of the RESPOND Toolkit and summarized their findings from initial pilot testing. They concluded that the RESPOND Toolkit has promise as an effective and scalable approach to providing community pharmacist-tailored training to promote behavioral shifts supporting opioid safety for patients.
AHRQ-funded; HS024227.
Citation: Alley L, Novak K, Havlin T .
Development and pilot of a prescription drug monitoring program and communication intervention for pharmacists
Res Social Adm Pharm 2020 Oct;16(10):1422-30. doi: 10.1016/j.sapharm.2019.12.023..
Keywords: Opioids, Substance Abuse, Medication, Medication: Safety, Patient Safety, Tools & Toolkits, Communication, Provider: Pharmacist, Provider, Training
Donovan E, Bratberg J, Baird J
Pharmacy leaders' beliefs about how pharmacies can support a sustainable approach to providing naloxone to the community.
The objective of this qualitative study was to understand how leaders in pharmacy organizations perceive pharmacies and pharmacy staff can optimize dispensing of naloxone. Five main themes emerged: importance of staff training to increase comfort; strength through coordination of efforts; pharmacies acting as community leaders in the opioid crisis; persisting stigma; ongoing workflow challenges. These results uniquely reflect the experiences and insights of pharmacy leaders implementing public health initiatives during the opioid crisis and can be used for gaining insight into how pharmacists can efficiently provide naloxone to their communities.
AHRQ-funded; HS024021.
Citation: Donovan E, Bratberg J, Baird J .
Pharmacy leaders' beliefs about how pharmacies can support a sustainable approach to providing naloxone to the community.
Res Social Adm Pharm 2020 Oct;16(10):1493-97. doi: 10.1016/j.sapharm.2020.01.006..
Keywords: Provider: Pharmacist, Provider, Community-Based Practice, Opioids, Medication, Substance Abuse
Jones AE, King JB, Kim K
The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring.
The objective of this study was to describe direct oral anticoagulant (DOAC) management in patients who were and were not managed by an anticoagulation management service (AMS). Subjects were patients with atrial fibrillation at the University of Utah Health (UUH) who received DOAC therapy. Results showed that patients managed by AMS providers were more complex and had more frequent encounters regarding their DOAC therapy than those managed by non-AMS providers. However, there was evidence of duplicative DOAC therapy management efforts. No difference between AMS and non-AMS groups in the composite clinical endpoint was detected.
AHRQ-funded; HS026156.
Citation: Jones AE, King JB, Kim K .
The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring.
J Thromb Thrombolysis 2020 Oct;50(3):739-45. doi: 10.1007/s11239-020-02064-0..
Keywords: Blood Thinners, Medication, Provider: Pharmacist, Provider, Care Management, Healthcare Delivery
Lozada MJ, Raji MA, Goodwin JS
Opioid prescribing by primary care providers: a cross-sectional analysis of nurse practitioner, physician assistant, and physician prescribing patterns.
The purpose of this study was to identify prescription opioid over-prescribers by comparing prescribing patterns of primary care physicians (MDs), nurse practitioners (NPs), and physician assistants (PAs). Participants were a national sample of 2015 Medicare Part D enrollees. Findings showed that most NPs/PAs prescribed opioids in a pattern similar to MDs, but NPs/PAs had more outliers who prescribed high-frequency, high-dose opioids than did MDs. Recommendations included efforts to reduce opioid overprescribing including targeted provider education, risk stratification, and state legislation.
AHRQ-funded; HS020642.
Citation: Lozada MJ, Raji MA, Goodwin JS .
Opioid prescribing by primary care providers: a cross-sectional analysis of nurse practitioner, physician assistant, and physician prescribing patterns.
J Gen Intern Med 2020 Sep;35(9):2584-92. doi: 10.1007/s11606-020-05823-0..
Keywords: Opioids, Medication, Primary Care, Practice Patterns, Medication: Safety, Provider: Nurse, Provider: Physician, Provider: Physician Assistant, Provider
Cotter JM, Tyler A, Reese J
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
This study looked at pediatric emergency department (ED) inpatient use of dexamethasone versus prednisone by providers for asthma treatment. A survey was distributed to providers who care for inpatient asthmatics. Ninety-two providers completed the survey. When patients received dexamethasone in the ED, 44% continued dexamethasone, 14% switched to prednisone, 2% stopped steroid use, and 40% said it depended on the circumstances. Hospitalists were significantly more likely to continue dexamethasone than pulmonologists (61% versus 15%). Switching to prednisone included factors such as severity of exacerbation (73%) and asthma history (47%). Just over half of providers (5f1%) felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.”
AHRQ-funded; HS026512.
Citation: Cotter JM, Tyler A, Reese J .
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
J Asthma 2020 Sep;57(9):942-48. doi: 10.1080/02770903.2019.1622713..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Medication, Inpatient Care, Care Management, Hospitalization, Emergency Department, Practice Patterns, Provider: Physician, Provider
Rhee TG, Olfson M, Nierenberg AA
20-year trends in the pharmacologic treatment of bipolar disorder by psychiatrists in outpatient care settings.
Pharmacological options for treating bipolar disorder have increased over the past 20 years, with several second-generation antipsychotics receiving regulatory approval in the 1990s. In this study the authors describe trends in use of pharmacological agents in the outpatient management of bipolar disorder. The authors concluded that substantial changes occurred in the treatment of bipolar disorder over the past 20 years, with second-generation antipsychotics in large measure supplanting traditional mood stabilizers.
AHRQ-funded; HS023000.
Citation: Rhee TG, Olfson M, Nierenberg AA .
20-year trends in the pharmacologic treatment of bipolar disorder by psychiatrists in outpatient care settings.
Am J Psychiatry 2020 Aug;177(8):706-15. doi: 10.1176/appi.ajp.2020.19091000..
Keywords: Behavioral Health, Medication, Practice Patterns, Ambulatory Care and Surgery, Provider: Physician, Provider
Zetts RM, Stoesz A, Garcia AM
Primary care physicians' attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study.
Outpatient antibiotic stewardship is needed to improve prescribing and address the threat of antibiotic resistance. A better understanding of primary care physicians (PCPs) attitudes towards antibiotic prescribing and outpatient antibiotic stewardship is needed to identify barriers to stewardship implementation and help tailor stewardship strategies. The aim of this study was to assess PCPs current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts.
AHRQ-funded; HS026506; HS024930; 233201500020I.
Citation: Zetts RM, Stoesz A, Garcia AM .
Primary care physicians' attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study.
BMJ Open 2020 Jul 14;10(7):e034983. doi: 10.1136/bmjopen-2019-034983..
Keywords: Primary Care, Antimicrobial Stewardship, Antibiotics, Medication, Provider: Physician, Provider
McClellan C, Flottemesch TJ, Ali MM
AHRQ Author: McClellan C
Physician networks and potentially inappropriate opioid prescriptions.
The authors examined associations between care networks defined by shared patients and problematic opioid prescribing using four behaviors defined by the CDC guidelines. They found that greater provider integration was associated with a lower risk of a provider's patients repeatedly having potentially inappropriate prescription fills; however, the association with a provider having any potentially problematic prescription was more ambiguous.
AHRQ-authored.
Citation: McClellan C, Flottemesch TJ, Ali MM .
Physician networks and potentially inappropriate opioid prescriptions.
J Addict Dis 2020 Jul-Sep;38(3):301-10. doi: 10.1080/10550887.2020.1760655..
Keywords: Opioids, Medication, Medication: Safety, Substance Abuse, Patient Safety, Provider
Snyder ME, Jaynes HA, Germant SA
Factors associated with comprehensive medication review completion rates: a national survey of community pharmacists.
The primary objective of this survey study was to identify factors associated with the comprehensive medication review (CMR) completion rates of community pharmacies contracted with a national medication therapy management (MTM) vendor. The investigators concluded that factors at the respondent (e.g., responses to facilitators scale) and pharmacy (e.g., pharmacy type) levels were associated with CMR completion rates. The investigators indicated that the findings could be used by MTM stakeholders to improve CMR completion rates.
AHRQ-funded; HS022119.
Citation: Snyder ME, Jaynes HA, Germant SA .
Factors associated with comprehensive medication review completion rates: a national survey of community pharmacists.
Res Social Adm Pharm 2020 May;16(5):673-80. doi: 10.1016/j.sapharm.2019.08.008..
Keywords: Medication, Provider: Pharmacist, Provider
Suda KJ, Zhou J, Rowan SA
Overprescribing of opioids to adults by dentists in the U.S., 2011-2015.
Dentists prescribe 1 in 10 opioid prescriptions in the U.S. When opioids are necessary, national guidelines recommend the prescription of low-dose opioids for a short duration. This study assessed the appropriate prescribing of opioids by dentists before guideline implementation. The investigators concluded that between 1 in 4 and 1 in 2 opioids prescribed to adult dental patients are overprescribed.
AHRQ-funded; HS025177.
Citation: Suda KJ, Zhou J, Rowan SA .
Overprescribing of opioids to adults by dentists in the U.S., 2011-2015.
Am J Prev Med 2020 Apr;58(4):473-86. doi: 10.1016/j.amepre.2019.11.006..
Keywords: Opioids, Dental and Oral Health, Provider, Practice Patterns, Medication
Kohut MR, Keller SC, Linder JA
AHRQ Author: Miller MA
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Researchers conducted semi-structured interviews with clinicians to determine how they perceive demand for antibiotics in the outpatient setting. They conducted interviews with 25 clinicians from nine practices across three states. Patient demand was the most common reason why non-indicated antibiotics were prescribed. Clinicians felt that if they didn’t prescribe them they would experience repercussions in their reputation and practice and that certain patients are impossible to please without an antibiotic prescription regardless of the diagnosis.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Kohut MR, Keller SC, Linder JA .
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Fam Pract 2020 Mar 25;37(2):276-82. doi: 10.1093/fampra/cmz066..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Ambulatory Care and Surgery, Provider: Clinician, Provider: Physician, Provider
Burstein D, Baird J, Bratberg J
Pharmacist attitudes toward pharmacy-based naloxone: a cross-sectional survey study.
This study examined pharmacist attitudes towards recommending pharmacy-based naloxone (PBN). The authors looked at the influence of gender, practice setting, number of years of practice, state location, and PBN involvement. Barriers and facilitators were also assessed. A 71-question survey was mailed to approximately 2900 licensed pharmacists in Massachusetts and Rhode Island and was open from April 5, 2016 until July 13, 2016. Out of those 2900, 402 responded (13%) and 245 were included in the analyses. The majority (79%) identified as White and 127 (51.8%) indicated that they had dispensed naloxone, with 85 having done so in the past 30 days. The results of the cross-sectional survey was used to develop the Opioid Overdose Prevention Attitude (OOPA) scale which consists of 3 subscales: Opioid Overdose Prevention Attitude, Public Health Attitude, and Naxolone Dispensing Attitude. Pharmacists working in a pharmacy that had a standing order or collaborative practice agreement to dispense naxolone without a physician’s prescription had a more positive attitude than other pharmacists.
AHRQ-funded; HS024021.
Citation: Burstein D, Baird J, Bratberg J .
Pharmacist attitudes toward pharmacy-based naloxone: a cross-sectional survey study.
J Am Pharm Assoc 2020 Mar-Apr;60(2):304-10. doi: 10.1016/j.japh.2019.11.004.
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Keywords: Medication, Provider: Pharmacist, Provider, Opioids, Substance Abuse, Prevention
Larach DB, Waljee JF, Hu HM
Patterns of initial opioid prescribing to opioid-naive patients.
Researchers sought to determine the proportion of initial opioid prescriptions for opioid-naive patients prescribed by surgeons, dentists, and emergency physicians. Data from a nationwide insurance claims dataset was used to study US adults aged 18 to 64 years. Over the study period, the researchers found that surgical patients received the highest proportion of potent opioids. They concluded that initial opioid prescribing attributable to surgical and dental care was increasing relative to primary and chronic pain care. They recommended evidence-based guideline development for surgical and dental prescribing in order to curb iatrogenic opioid morbidity and mortality.
AHRQ-funded; HS023313.
Citation: Larach DB, Waljee JF, Hu HM .
Patterns of initial opioid prescribing to opioid-naive patients.
Ann Surg 2020 Feb;271(2):290-95. doi: 10.1097/sla.0000000000002969..
Keywords: Opioids, Medication, Practice Patterns, Provider: Physician, Provider
Goyal P, Anderson TS, Bernacki GM
Physician perspectives on deprescribing cardiovascular medications for older adults.
Investigators sought to characterize and compare clinician perspectives regarding deprescribing cardiovascular medications for older adults across three specialties. Within each specialty, 750 physicians were surveyed. The investigators found that, while barriers to deprescribing cardiovascular medications were shared across specialties, reasons for deprescribing, especially in the setting of limited life expectancy, varied. They concluded that implementing deprescribing will require improved processes for both physician-physician and physician-patient communication.
AHRQ-funded; HS022982.
Citation: Goyal P, Anderson TS, Bernacki GM .
Physician perspectives on deprescribing cardiovascular medications for older adults.
J Am Geriatr Soc 2020 Jan;68(1):78-86. doi: 10.1111/jgs.16157..
Keywords: Elderly, Medication, Cardiovascular Conditions, Shared Decision Making, Provider: Physician, Provider