Sustainability of a “just in time” educational strategy to optimize opioid prescribing in outpatient dialysis access surgery

Abstract

Objective

Surgeons continue to contribute to opioid overprescribing. Although many prior interventions have effectively addressed this problem, intervention sustainability remains an important aspect of combatting the opioid epidemic. In this study, we sought to determine the sustainability of a “just in time” educational strategy to optimize opioid prescribing in outpatient dialysis access surgery.

Methods

We distributed an informational handout with opioid prescribing recommendations to residents at the start of their vascular surgery rotations. We then reviewed patient charts from 4 years before and 2 years after the start of this intervention (January 1, 2018-December 1, 2023). We compared the percentage of patients prescribed opioids during the pre-intervention and intervention periods. To determine the role of possible confounders, we also performed logistic regression controlling for patient characteristics. For patients prescribed opioids, we compared the total oral morphine equivalents (OMEs) prescribed during the pre-intervention and intervention periods. We further assessed whether opioid prescribing or OMEs prescribed changed from the first to the second years of the intervention.

Results

During the 6-year study period, 368 patients underwent upper extremity dialysis access procedures. Significantly fewer patients received opioids during the intervention period, with 58% of patients (140 of 241) receiving a prescription in the pre-intervention period and 35% (44 of 127) receiving a prescription in the post-intervention period (P < .001). In a regression model controlling for patient characteristics, only the intervention and use of regional block were associated with decreased risk of being prescribed opioids (P < .001). Among patients who received opioid prescriptions, the median OMEs prescribed decreased from 90 in the pre-intervention period to 45 in the intervention period (P < .001). Opioid prescribing did not change significantly between the first and second years of the intervention, but there was an improvement in adherence to prescribing guidelines in the second year.

Conclusions

We identified that a simple, low-resource, email-based intervention was associated with a significant, sustained decrease in opioid prescriptions for patients undergoing dialysis access surgery. Other programs may consider adopting such an approach given its ease of implementation with few resources.