Proposed objectives 1. Evaluate the impact of the Utah Clinical Guidelines on Prescribing Opioids. 2. Evaluate the impact of an educational intervention that teaches clinicians how to interpret and use the guidelines. Importance Unintentional fatalities due to prescription medications are an increasing problem in Utah and the United States. In Utah, the annual number of prescription drug-related overdose deaths began to increase substantially in 2001 and the increase has continued through 2007. Since 2003 the leading cause of injury death in Utah has been poisoning from prescription drugs - with opioid-related poisonings as the primary offender. During the years 1997-2007 deaths attributed to non-illicit drug poisoning increased by approximately 290% in Utah from 4 per 100,000 person-years to 12 per 100,000 person-years. The increase was largely due to deaths from prescription opioid pain medications. The number of emergency department encounters stemming from prescription drug overdose has also continued to increase in Utah from 2001-present.4, 5 Evaluation will allow provide valuable information that will help other states adopt or adapt similar opioid pain management recommendations. Objectives Through this evaluation we aim to determine the impact the guidelines have on prescribing patterns and safety monitoring. We also aim to evaluate which tools from the guidelines the physician's are incorporating into their practice. In addition, we plan to evaluate the impact of the educational intervention on following guideline recommendations. Our hypothesis is that the physicians who receive education on how to use the guidelines will be associated with the biggest improvement in pain treatment. Study Design This study proposes to compare pain management practices for the entire state before and after the prescribing guidelines were finalized and supported by Utah Department of Health. We also plan a clinic- randomized design to evaluate the impact of an intensive educational intervention designed to teach providers how to use the guideline and tools for improving the safety of opioid treatment. Comparison will be done using multiple databases state-level databases that include the Utah Controlled Substance Database, the Utah All Payer Data, Vital Records, and Utah Emergency Department Encounter Data. To evaluate the impact of the interventions we will measure change in prescribing patterns, safety monitoring, use of tools, and adverse drug events. Physicians'will also be asked to self-report the change in their practice through a survey. Setting Evaluation of these interventions will be done at the Utah Department of Health (UDOH) using databases that are housed and managed at the UDOH. The educational intervention takes place in clinics and hospitals across the state of Utah. Data is then collected from participating physicians via an online survey. Participants This study proposes to evaluate all opioid prescribers in the state in the pre and post guideline comparison. Approximately 300 providers will be enrolled in the intensive educational intervention and 300 controls. We also propose to conduct chart-review on 88 Utah Community Clinic providers to determine how the educational intervention impacted their use of tools and documentation. Outcome Measures 1. Changes in prescribing patterns of physicians 2. Changes in the number of EKGs and Sleep Studies ordered by physicians 3. Reduction in number of adverse events (opioid-related emergency department visits and deaths). 4. Changes in the tools used by physicians (e.g. treatment plans, dosing guidelines)

Public Health Relevance

Project Narrative: This proposed project is relevant to public health because of the potential it has to provide scientifically based evidence for the use and implementation of prescribing guidelines to reduce morbidity and mortality related to prescription pain medications.

National Institute of Health (NIH)
National Center for Injury Prevention and Control (NCIPC)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZCE1-JXS (05))
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Blackman, Donald
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Utah State Department of Health
Salt Lake City
United States
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Porucznik, Christina A; Johnson, Erin M; Rolfs, Robert T et al. (2014) Specialty of prescribers associated with prescription opioid fatalities in Utah, 2002-2010. Pain Med 15:73-8
Cheng, Melissa; Sauer, Brian; Johnson, Erin et al. (2013) Comparison of opioid-related deaths by work-related injury. Am J Ind Med 56:308-16
Porucznik, Christina A; Johnson, Erin M; Rolfs, Robert T et al. (2013) Opioid prescribing knowledge and practices: provider survey following promulgation of guidelines-Utah, 2011. J Opioid Manag 9:217-24