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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 13 of 13 Research Studies DisplayedCalcaterra SL, Martin M, Bottner R
Management of opioid use disorder and associated conditions among hospitalized adults: a consensus statement from the Society of Hospital Medicine.
This paper discusses the findings of a Society of Hospital Medicine working group convened to develop a Consensus Statement on the management of opioid use disorder (OUD) and associated conditions among hospitalized adults. The statement is intended for clinicians practicing medicine in the inpatient setting (e.g., hospitalists, primary care physicians, family physicians, advanced practice nurses, and physician assistants) and is intended to apply to hospitalized adults at risk for, or diagnosed with, OUD. The first step of the working group to develop the statement was to conduct a systematic review of relevant guidelines and compose a draft statement based on extracted recommendations. In the next step the working group obtained feedback on the draft statement from external experts in addiction medicine, SHM members, professional societies, harm reduction organizations and advocacy groups, and peer reviewers. This iterative development process resulted in a final Consensus Statement consisting of 18 recommendations covering the following topics: (1) identification and treatment of OUD and opioid withdrawal, (2) perioperative and acute pain management in patients with OUD, and (3) methods to optimize care transitions at hospital discharge for patients with OUD.
AHRQ-funded; HS026215.
Citation: Calcaterra SL, Martin M, Bottner R .
Management of opioid use disorder and associated conditions among hospitalized adults: a consensus statement from the Society of Hospital Medicine.
J Hosp Med 2022 Sep;17(9):744-56. doi: 10.1002/jhm.12893..
Keywords: Opioids, Substance Abuse, Behavioral Health, Evidence-Based Practice, Guidelines, Inpatient Care
Calcaterras SL, Bottner R, Martin M
Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: a systematic review of existing guidelines.
This study evaluated the quality and content of existing guidelines for in-hospital opioid use disorder (OUD) treatment and management. A literature search was done on several databases, websites of relevant societies and advocacy organizations, and selected international search engines. Nineteen guidelines published between January 2010 and June 2020 met the selection criteria. The majority of guidelines were based on observational studies or expert consensus. They recommended the use of nonstigmatizing language among patients with OUD; to assess patients with unhealthy opioid use for OUD using the Diagnostic Statistical Manual of Diseases-5th Edition criteria; use of methadone or buprenorphine to treat OUD and opioid withdrawal; use of multimodal, nonopioid therapy, and when needed, short-acting opioid analgesics in addition to buprenorphine or methadone, for acute pain management; ensuring linkage to ongoing methadone or buprenorphine treatment; referring patients to psychosocial treatment; and ensuring access to naloxone for opioid overdose reversal.
AHRQ-funded; HS026215.
Citation: Calcaterras SL, Bottner R, Martin M .
Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: a systematic review of existing guidelines.
J Hosp Med 2022 Sep;17(9):679-92. doi: 10.1002/jhm.12908..
Keywords: Opioids, Substance Abuse, Behavioral Health, Evidence-Based Practice, Guidelines, Inpatient Care
Cedillo G, George MC, Deshpande R
Toward safer opioid prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial.
Healthcare and behavioral health providers are lacking a methodology to implement the 2016 U.S. Centers for Disease Control and Prevention Opioid Prescribing Guideline (CDC Guideline), measure prescriber adherence to it, and systematically test its effect on patient and public health outcomes. The Guideline is currently being reviewed and revised due to concern that it may be harmful to people with chronic pain on long-term opioid therapy (CP-LTOT). The purpose of the study was to develop and test a CDC Guideline implementation strategy termed “TOWER,” focused on an outpatient HIV primary care setting with patients with CP-LTOT. The TOWER strategy included: 1) a patient-facing app for opioid management (OM-App); 2) a template for progress notes (OM-Note) intended to guide the patient’s office visit; and 3) a primary care provider (PCP) training. TOWER was developed in a multi-step, stakeholder-engaged process within a behavioral change framework. The researchers evaluated the TOWER strategy in a randomized-controlled trial of HIV-PCPs (N=11) and their patients with HIV and CP-LTOT (N=40). The main outcome was CDC Guideline adherence based on electronic health record (EHR) documentation and measured by the Safer Opioid Prescribing Tool (SOPTET). Qualitative data was also collected, including one-on-one PCP interviews. The study found that the PCPs randomized to utilize the TOWER strategy were 48% more CDC Guideline adherent. Qualitative data reflected high levels of intervention provider confidence in administering the TOWER processes, and that the OM-Note supported provider efforts, but experience with the patient-facing OM-App was mixed. The study concluded that adherence to the 2016 CDC Guidelines is not associated with worsening of outcomes for people with HIV with CP-LTOT, and adherence to the CDC Guidelines can be promoted and measured. The researchers recommend additional research into the scalability of these results and the impact of CDC Guideline adherence on public health.
AHRQ-funded; HS025641.
Citation: Cedillo G, George MC, Deshpande R .
Toward safer opioid prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial.
Addict Sci Clin Pract 2022 May 16;17(1):28. doi: 10.1186/s13722-022-00311-8..
Keywords: Opioids, Medication, Human Immunodeficiency Virus (HIV), Guidelines, Evidence-Based Practice
Navis A, George MC, Nmashie A
Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines.
This study assessed the use of the Safer Opioid Prescribing Evaluation Tool (SOPET) which was designed to improve the implementation of the 2016 Centers for Disease Control Guidelines on the prescription of opioids for chronic pain. Four raters with varying levels of clinical experience were trained to use the SOPET and then used it to evaluate 21 baseline patient scenarios. Inter-rater reliability was measured using intraclass correlation coefficient (ICC) estimates and their 95% confidence intervals for the total SOPET score based on a mean-rating absolute-agreement, two-way random-effects model. Inter-rater reliability was found to be good for the three physician raters (0.92, 0.97, and 0.99). However, inter-rater reliability for the non-physician rater was lower (0.67).
AHRQ-funded; HS025641.
Citation: Navis A, George MC, Nmashie A .
Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines.
Pain Med 2020 Dec 25;21(12):3655-59. doi: 10.1093/pm/pnaa138..
Keywords: Opioids, Medication, Medication: Safety, Patient Safety, Guidelines, Practice Patterns, Pain, Chronic Conditions, Evidence-Based Practice
Heins SE, Castillo RC
The impact of morphine equivalent daily dose threshold guidelines on prescribed dose in a workers' compensation population.
This study evaluated the impact of dissemination Morphine Equivalent Daily Dose (MEDD) guidelines to state workers’ compensation boards to discourage high-dose opioid use among injured workers receiving workers’ compensation. The study used workers compensations claims data from 2010-2013 from 2 guideline states and 3 control states. The policy implementation showed a 9.26 mg decrease in MEDD after adjusting for covariates, state fixed-effects, and time trends. The decreases became more pronounced over the study period.
AHRQ-funded; HS025557.
Citation: Heins SE, Castillo RC .
The impact of morphine equivalent daily dose threshold guidelines on prescribed dose in a workers' compensation population.
Med Care 2020 Mar;58(3):241-47. doi: 10.1097/mlr.0000000000001269..
Keywords: Opioids, Medication, Pain, Chronic Conditions, Practice Patterns, Guidelines
Jeffery MM, Hooten WM, Jena AB
Rates of physician coprescribing of opioids and benzodiazepines after the release of the Centers for Disease Control and Prevention guidelines in 2016.
Researchers sought to determine whether the release of the CDC guidelines was associated with changes in co-prescription of opioids and benzodiazepines. Their study showed a reduction in the extent, but not the intensity, of co-prescribing of benzodiazepines for patients with long-term opioid use.
AHRQ-funded; HS025164.
Citation: Jeffery MM, Hooten WM, Jena AB .
Rates of physician coprescribing of opioids and benzodiazepines after the release of the Centers for Disease Control and Prevention guidelines in 2016.
JAMA Netw Open 2019 Aug 2;2(8):e198325. doi: 10.1001/jamanetworkopen.2019.8325..
Keywords: Opioids, Medication, Practice Patterns, Pain, Evidence-Based Practice, Guidelines
Callaghan BC, Reynolds E, Banerjee M
Longitudinal pattern of pain medication utilization in peripheral neuropathy patients.
The authors of this article investigated the pattern and utilization of neuropathic pain medications in peripheral neuropathy patients. They found that opioid initiation and transition to chronic opioid therapy were frequent in the studied population despite few patients receiving more than one guideline-recommended medication. They concluded that efforts are needed to decrease opioid utilization and to increase guideline-recommended medication use in order to improve current neuropathic pain treatment.
AHRQ-funded; HS017690.
Citation: Callaghan BC, Reynolds E, Banerjee M .
Longitudinal pattern of pain medication utilization in peripheral neuropathy patients.
Pain 2019 Mar;160(3):592-99. doi: 10.1097/j.pain.0000000000001439..
Keywords: Chronic Conditions, Guidelines, Healthcare Utilization, Medication, Neurological Disorders, Opioids, Pain, Practice Patterns
Howard R, Waljee J, Brummett C
Reduction in opioid prescribing through evidence-based prescribing guidelines.
The authors evaluated the effect of evidence-based postoperative prescribing guidelines in an effort to reduce overprescribing. The post-intervention group received opioid prescriptions for reduced dosages compared to the pre-intervention group. In the post-intervention group, 2.5% requested refills compared with 4.1% in the pre-intervention group. The authors indicated that this work will be used as a template for statewide practice transformation, which may serve as a platform for other states.
AHRQ-funded; HS023313.
Citation: Howard R, Waljee J, Brummett C .
Reduction in opioid prescribing through evidence-based prescribing guidelines.
JAMA Surg 2018 Mar;153(3):285-87. doi: 10.1001/jamasurg.2017.4436.
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Keywords: Evidence-Based Practice, Guidelines, Opioids, Practice Patterns, Surgery
Kim HS, McCarthy DM, Hoppe JA
Emergency department provider perspectives on benzodiazepine-opioid coprescribing: a qualitative study.
This study examined attitudes of emergency department residents, attending physicians, and pharmacists from three hospitals on coprescribing benzodiazepines and opioids. There is mounting evidence that this increases overdose risk. Focus groups were conducted using semistructured interviews which were audio-recorded and transcribed. Participants were reluctant to admit coprescribing and said when they did that specific discharge instructions were provided. The decision was also influenced by a provider’s belief in the efficacy of combination therapy as well as self-imposed pressure to escalate care or avoid hospital admission. They did not like the idea of using computerized alerts, but were support of pharmacist-assisted interventions.
AHRQ-funded; HS023011; HS000078.
Citation: Kim HS, McCarthy DM, Hoppe JA .
Emergency department provider perspectives on benzodiazepine-opioid coprescribing: a qualitative study.
Acad Emerg Med 2018 Jan;25(1):15-24. doi: 10.1111/acem.13273..
Keywords: Emergency Department, Guidelines, Medication, Opioids, Practice Patterns, Provider: Clinician, Provider: Pharmacist, Provider: Physician
Meisel ZF, Metlay JP, Sinnenberg L
A randomized trial testing the effect of narrative vignettes versus guideline summaries on provider response to a professional organization clinical policy for safe opioid prescribing.
The authors compared whether narrative vignettes embedded in the American College of Emergency Physicians (ACEP) daily e-newsletter improved dissemination of the clinical policy to ACEP members, and engagement of members with the clinical policy, compared with traditional summary text. They found that the vignettes outperformed traditional guideline text in promoting engagement with an evidence-based clinical guideline related to opioid prescriptions.
AHRQ-funded; HS021956.
Citation: Meisel ZF, Metlay JP, Sinnenberg L .
A randomized trial testing the effect of narrative vignettes versus guideline summaries on provider response to a professional organization clinical policy for safe opioid prescribing.
Ann Emerg Med 2016 Dec;68(6):719-28. doi: 10.1016/j.annemergmed.2016.03.007.
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Keywords: Communication, Evidence-Based Practice, Guidelines, Opioids, Medication, Medication: Safety, Policy, Provider
Gaither JR, Goulet JL, Becker WC
The association between receipt of guideline-concordant long-term opioid therapy and all-cause mortality.
The researchers' objective was to determine the association between receipt of guideline-concordant long-term opioid therapy (LtOT) and 1-year all-cause mortality. They found no association between all-cause mortality and primary care visits or urine drug testing and recommended that providers use caution in initiating LtOT in conjunction with benzodiazepines and untreated substance use disorders.
AHRQ-funded; HS021112.
Citation: Gaither JR, Goulet JL, Becker WC .
The association between receipt of guideline-concordant long-term opioid therapy and all-cause mortality.
J Gen Intern Med 2016 May;31(5):492-501. doi: 10.1007/s11606-015-3571-4.
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Keywords: Guidelines, Mortality, Opioids, Patient-Centered Outcomes Research, Substance Abuse
Kilaru AS, Gadsden SM, Perrone J
How do physicians adopt and apply opioid prescription guidelines in the emergency department? A qualitative study.
This qualitative study of emergency physicians attempted to gain insight into the adoption, use, and perceived relevance of opioid-prescribing guidelines. Most of the 61 participants interviewed in a convenience sample had a positive perspective on the intent and role of such guidelines and used them most commonly as communication tools with patients.
AHRQ-funded; HS021956.
Citation: Kilaru AS, Gadsden SM, Perrone J .
How do physicians adopt and apply opioid prescription guidelines in the emergency department? A qualitative study.
Ann Emerg Med 2014 Nov;64(5):482-89.e1. doi: 10.1016/j.annemergmed.2014.03.015.
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Keywords: Emergency Medical Services (EMS), Opioids, Pain, Guidelines, Practice Patterns
Nuckols TK, Anderson L, Popescu I
Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain.
This review evaluated the quality and content of guidelines on the use of opioids for chronic pain. Despite limited evidence and variable development methods, it concluded that recent guidelines on chronic pain agree on several opioid risk mitigation strategies, including upper dosing thresholds; cautions with certain medications; attention to drug–drug and drug–disease interactions; and use of risk assessment tools, treatment agreements, and urine drug testing.
AHRQ-funded; HS017954.
Citation: Nuckols TK, Anderson L, Popescu I .
Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain.
Ann Intern Med 2014 Jan 7;160(1):38-47. doi: 10.7326/0003-4819-160-1-201401070-00732..
Keywords: Opioids, Pain, Guidelines, Medication, Evidence-Based Practice, Chronic Conditions