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A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits

	Photo: emergency department signA study published in The Journal of Emergency Medicine indicates emergency department (ED) care coordination programs can help patients obtain the appropriate level of care while reducing ED visits and opioid prescribing by ED providers. A citywide ED care coordination program was implemented among frequent ED users in the south-central Washington Tri-Cities area from July 2012 to 2013.

During the study, individualized ED care recommendations for patients in the intervention group were provided through an ED information exchange system to help guide patient care. Participants in the intervention group experienced a 34% decrease in ED visits, and were 80% less likely to receive an opioid prescription from the ED, compared to the control group.

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An analysis of Washington prescription drug monitoring program (PDMP) data revealed that multiple provider episodes (MPEs) vary by age group and class of prescription drug. Opioids and opioid combinations had the highest number of days of overlapping prescriptions, and eight opioids had a mean daily dosage greater than 120 morphine milligram equivalents (MME). Findings indicate that MPEs, overlapping prescription, and mean daily dosages over 100 MMEs are patient risk factors to look for in PDMP data.

Maine’s PDMP data was analyzed to examine several patient risk measures for prescription drug misuse, abuse and overdose. Patients aged 35-54 had the highest rate of MPEs, and opioids were the drug class most frequently involved with MPEs. However, the rate of MPEs declined from 2010 to 2014, and this coincided with an increase in prescribing of buprenorphine, widely used in treating opioid dependence.

	Assess. Manage. Monitor. Guideline for Prescribing Opioids for Chronic Pain