This application addresses the FOA: Research on Integration of Injury Prevention in Health Systems (U01). Unintentional drug overdoses with prescription medication have reached alarming numbers and while a number of local, state and national initiatives are underway there has been a sharp rise in overdose deaths since 2001. Prescription narcotic misuse accounts for nearly half a million emergency department visits a year and there is a great need for physicians and healthcare providers to be aware of the problem and impact on the patients they serve. A coordinated effort among various physicians and other healthcare providers, researchers, government agencies and the community can reduce the abuse, over prescription and burden of injury of opioid analgesics. The objectives of the proposed study are to implement and assess the ability of an electronic alert to affect prescribing behavior and reduce morbidity and mortality within a large healthcare system.
The specific aims are: 1.To assess implementation and changes in prescribing behavior of physicians and healthcare providers when presented immediate feedback on potential misuse or abuse of prescription narcotics through electronic alerts. 2. To compare rates of outpatient prescription narcotic complications before and after implementation of an immediate computerized reporting system. 3. To map prescriber and patient behavior in response to implementation of an immediate computerized reporting system for prescription narcotics. The proposed research will provide evidence that immediate feedback to prescribers on prescription pain medication utilization will lead to a reduction in the prescription of high dose opioids, co-prescribing of opioids with other controlled substances and reduce the number of prescriptions from multiple providers. Additionally, this intervention will combat the prescription narcotic overdose epidemic by identifying and addressing high-risk patients throughout the continuum of their care. This contribution will be highly significant because it will change prescribing behavio, reduce unintentional drug overdoses and ultimately serve as a model that can be implemented into other communities

Public Health Relevance

The proposed research is relevant to public health because it will determine if implementation of an alert within the electronic medical record is an effective way to improve opioid prescribing behavior and ultimately reduce morbidity and mortality due to prescription narcotic overdose. Given the public health burden of injury, this valuable information will serve as a model for prescription drug monitoring in large healthcare systems and addresses high-risk patients at all stages of their care. Thus, this research is directly applicable to the NCIPC and CDC objective of developing an evidence base for clinical services that identify a model to reduce the burden of injury due to prescriptions narcotics.

National Institute of Health (NIH)
National Center for Injury Prevention and Control (NCIPC)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZCE1)
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Carolinas Medical Center
United States
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Ruder, John; Wally, Meghan K; Oliverio, McKell et al. (2017) Patterns of Opioid Prescribing for an Orthopaedic Trauma Population. J Orthop Trauma 31:e179-e185
Seymour, Rachel B; Leas, Daniel; Wally, Meghan K et al. (2016) Prescription reporting with immediate medication utilization mapping (PRIMUM): development of an alert to improve narcotic prescribing. BMC Med Inform Decis Mak 16:111