Opioid Prescription in Ophthalmology and the Impact of a Decision Support Tool in Reducing Excess Dosing

Victoria Blaga; Kanika Seth; Carolina Valentim; Aneesha Kalur; Justin Muste; Rishi P Singh; Katherine E Talcott

doi:10.1016/j.ajo.2022.06.019

Opioid Prescription in Ophthalmology and the Impact of a Decision Support Tool in Reducing Excess Dosing

Am J Ophthalmol. 2022 Nov:243:34-41. doi: 10.1016/j.ajo.2022.06.019. Epub 2022 Jul 6.

Authors

Victoria Blaga¹, Kanika Seth², Carolina Valentim², Aneesha Kalur², Justin Muste², Rishi P Singh³, Katherine E Talcott⁴

Affiliations

¹ From the Case Western Reserve University School of Medicine (V.B., R.P.S., K.E.T.).
² Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic (K.S., C.V., A.K., J.M., R.P.S., K.E.T.), Cleveland, Ohio, USA.
³ From the Case Western Reserve University School of Medicine (V.B., R.P.S., K.E.T.); Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic (K.S., C.V., A.K., J.M., R.P.S., K.E.T.), Cleveland, Ohio, USA.
⁴ From the Case Western Reserve University School of Medicine (V.B., R.P.S., K.E.T.); Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic (K.S., C.V., A.K., J.M., R.P.S., K.E.T.), Cleveland, Ohio, USA. Electronic address: talcotk@ccf.org.

PMID: 35809659
DOI: 10.1016/j.ajo.2022.06.019

Abstract

Purpose: To characterize opioid prescribing in ophthalmology and to determine the impact of an alert system on opioid prescription patterns.

Design: Retrospective pre- and post-implementation study.

Methods: The study population included individuals aged ≥18 years who received opioids written by ophthalmologists within a tertiary care center between January 3, 2015, and November 3, 2021, in the context of an opioid alert system. Mean morphine equivalent daily dose (MEDD) per prescription was compared before and after implementation of the opioid alert system. Additionally, mean MEDD per prescription was compared based on patient demographics and diagnoses.

Results: A total of 8014 individual patients were included in this study. The study population received a total of 9055 prescriptions, 77% of which were written for pain management related to an ophthalmic surgery. Mean MEDD per prescription decreased by 15.17 after implementation of the alert system (P < .001). A higher mean MEDD per prescription was observed among males (33.53 MEDD; P < .001). Black individuals received a higher mean MEDD per prescription (33.93 MEDD) compared with white individuals (32.80 MEDD; P = .03). Opioids written for disorders of the eyelid, lacrimal system, and orbit constituted 57.4% of total prescriptions.

Conclusions: Prescription patterns based on patient demographics and diagnoses can provide foci for opioid prescription reform in ophthalmology. The observed decrease in opioid dosage may indicate realization of the alert system.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Analgesics, Opioid* / therapeutic use
Drug Prescriptions
Humans
Male
Morphine Derivatives
Ophthalmology*
Practice Patterns, Physicians'
Retrospective Studies

Substances

Analgesics, Opioid
Morphine Derivatives

Grants and funding

P30 EY025585/EY/NEI NIH HHS/United States