ABSTRACT
BACKGROUND: Available data have shown steady increases of drug overdose deaths between 1992 and 2011. We review evidenced-based recommendations provided by a few prominent North American pain societies and suggest ways on how health providers might help reduce opioid analgesic deaths by implementing these practices. OBJECTIVE: To identify health care providers' roles in reducing opioid analgesic deaths. STUDY DESIGN: A comprehensive review of current literature. METHODS: The review included relevant literature identified through searches of MEDLINE, Cochran reviews, and Google Scholar, PubMed and EMBASE from January 1998 to January 2014. The level of evidence was classified as I (good), II (fair), and III (limited) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). RESULTS: Several practices such as too high doses overall, giving too high doses to opioid naive patients, too fast opioid titration, insufficient use and knowledge of urine drug testing, not updating knowledge of drug metabolism/interactions, and inadequate patient monitoring are associated with higher risks of opioid analgesic deaths. Suboptimal risk stratification of patients, rotation practices, and use of opioids analgesics in chronic noncancer pain are also associated factors. LIMITATIONS: There were a paucity of good evidence studies which show recommendations reduce death. CONCLUSION: Providers should be aware of all associated factors with opiate analgesic deaths and apply the available evidence in reducing opioid analgesic deaths.
Subject(s)
Analgesics, Opioid/adverse effects , Chronic Pain/drug therapy , Chronic Pain/mortality , Drug Overdose/mortality , Health Personnel , Analgesics/therapeutic use , Analgesics, Opioid/therapeutic use , Drug Overdose/prevention & control , Health Personnel/standards , Humans , Pain/drug therapy , Pain/mortality , Substance Abuse Detection/methods , Substance Abuse Detection/mortality , Substance Abuse Detection/standards , United States/epidemiologyABSTRACT
Dropping out of scheduled care leads to medication non adherence, increased morbidity, relapse and readmission rates. As part of a performance improvement project to increase attendance rates at our outpatient clinic, psychiatric residents and Behavioral Health Technicians made reminder telephone calls under similar circumstances. We compared follow up appointment rates in the two groups. Our analysis showed that there was no significant difference in the rates of kept appointment overall between the two groups. The important finding is physician time could be better spent in other patient care duties and reminder calls could be delegated to other health staff.
