Open Access Open Access  Restricted Access Subscription or Fee Access

Evaluating patients who present with pain complaints to a community hospital emergency department: Opioid prescription tracking software versus provider gestalt

Zach Hampton, DO, Justin Thai, DO, Christine Rukamp, DO, William Zackowski, DO, Danni Schneider, DO, Kimberly Cunagin, DO, Anand Gupta, MBBS, MPH, Andy Little, DO

Abstract


Objective: This study aimed to compare provider gestalt to assigned Narx score, a common prescription drug monitoring program (PDMP) component that gauges the patient's risk of misuse or abuse.

Design: This is a prospective, anonymous survey from advanced practice providers (APPs), emergency medicine residents, and emergency medicine attendings.

Setting: Data from two emergency departments (EDs) within the OhioHealth network were included. One hospital is a 213-bed academic, community hospital. The other hospital is a 434-bed academic level I trauma center.

Patients, Participants: The survey was open to all providers. Exclusion criteria for patients included prior knowledge of the patient and/or their Narx score, or cancer-related pain.

Interventions: Surveys were collected over a 3-month period. Variables included provider type and level of experience, participant demographics, provider gestalt, and the patient's actual Narx score.

Main Outcome Measure(s): Primary outcome was the ability of providers to accurately estimate a patient's Narx score. Groups were defined as Match = No (gestalt and actual score did not match) and Match = Yes (gestalt and actual score matched). Various characteristics were compared between these two groups.

Results: Providers were able to accurately estimate actual Narx score (72.7 percent). The Match = Yes group was younger (p = 0.01). Dental pain was more common in the Match = No group, 11.5 percent versus 0 percent (p = 0.02). Match = No group also had a higher incidence of triggers. Specifically, any trigger (p = 0.006), explicitly asking for pain medication (p = 0.03), and asking for opioids by name (p = 0.03). Every 10-year decrease in age showed a 1.5 times increased likelihood of accurately estimating Narx score (p = 0.02). Having no triggers showed a three times increased likelihood of accurately estimating Narx score (p = 0.02). Prescribing was largely unchanged after viewing the actual Narx score.

Conclusions: Providers are able to accurately estimate Narx score, though there are limiting factors. Older patients, those with dental pain, and those who give specific triggers are more difficult to estimate. Providers did not change their prescribing patterns after viewing the actual Narx score. Overestimation versus underestimation of Narx score was not directly studied.


Keywords


opioids, emergency department, Narx score, NARxCHECK, PDMP, OARRS, Prescription

Full Text:

PDF

References


Han B, Compton WM, Blanco C, et al.: Prescription opioid use, misuse, and use disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017; 167(5): 293-301.

Centers for Disease Control and Prevention. Opioid painkiller prescribing: Where you live makes a difference. 2015. Available at http://cdc.gov/vitalsigns/opioid-prescribing/index.html. Accessed November 13, 2015.

Ohio Automated Rx Reporting System (OARRS): Available at www.ohiopmp.gov. Accessed May 15, 2018.

Hall AJ, Logan JE, Toblin RL, et al.: Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008. 10; 300(22): 2613-2620.

Paulozzi LJ, Kilbourne EM, Shah NG, et al.: A history of being prescribed controlled substances and risk of drug overdose death. Pain Med. 2012; 13(1): 87-95.

Yang Z, Wilsey B, Bohm M, et al.: Defining risk of prescription opioid overdose: Pharmacy shopping and overlapping prescriptions among long-term opioid users in medicaid. J Pain. 2015; 16(5): 445-453.

Adewumi AD, Hollingworth SA, Maravilla JC, et al.: Prescribed dose of opioids and overdose: A systematic review and metaanalysis of unintentional prescription opioid overdose. CNS Drugs. 2018; 32(2): 101-116.

Huizenga JE, Breneman BC, Patel VR, et al.: NARxCheck score as a predictor of unintentional overdose deaths. 2016. Available at https://apprisshealth.com/wp-content/uploads/sites/2/2017/02/NARxCHECK-Score-as-a-Predictor.pdf. Accessed January 11, 2018.

Physician practice electronic health record integration with a prescription drug monitoring program: A pilot study. 2012. Available at https://www.healthit.gov/sites/default/files/ohio_pdmp_pilot_study_0.pdf. Accessed May 15, 2018.

Manchikanti L, et al.: Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Phys. 2017; 20(2S): S3-S92.

Paice JA: Cancer pain management and the opioid crisis in America: How to preserve hard-earned gains in improving the quality of cancer pain management. Cancer. 2018; 124(12): 2491-2497.

Baehren DF, Marco CA, Droz DE, et al.: A statewide prescription monitoring program affects emergency department prescribing behaviors. Ann Emerg Med. 2010; 56(1): 19-23. doi:10.1016/j.annemergmed.2009.12.011.

Harris PA, Taylor R, Thielke R, et al.: Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009; 42(2): 377-381.

Harris PA, Taylor R, Minor BL, et al.: The REDCap consortium: Building an international community of software partners. J Biomed Inform. 2019; 95: 103208. doi: 10.1016/j.jbi.2019.103208.

Weiner SG, Griggs CA, Mitchell PM, et al.: Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department. Ann Emerg Med. 2013; 62(4): 281-289. https://doi.org/10.1016/j.annemergmed.2013.05.025.

Centers for Disease Control and Prevention: U.S. Opioid Prescribing Rate Maps. Available at https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html. Accessed May 24, 2019.




DOI: https://doi.org/10.5055/jom.2020.0579

Refbacks

  • There are currently no refbacks.