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Blackburn NA, Joniak-Grant E, Nocera M, Dorris SW, Dasgupta N, Chelminski PR, Carey TS, Wu LT, Edwards DA, Marshall SW, Ranapurwala SI. Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives. BMC Health Serv Res 2021; 21:1191. [PMID: 34732177 PMCID: PMC8565171 DOI: 10.1186/s12913-021-07230-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent increases in state laws to reduce opioid prescribing have demonstrated a need to understand how they are interpreted and implemented in healthcare systems. The purpose of this study was to explore the systems, strategies, and resources that hospital administrators and prescribers used to implement the 2017 North Carolina Strengthen Opioid Prevention (STOP) Act opioid prescribing limits, which limited initial prescriptions to a five (for acute) or seven (for post-surgical) days' supply. METHODS We interviewed 14 hospital administrators and 38 prescribers with degrees in medicine, nursing, pharmacy, business administration and public health working across North Carolina. Interview guides, informed by the Consolidated Framework for Implementation Research, explored barriers and facilitators to implementation. Interview topics included communication, resources, and hospital system support. Interviews were recorded and transcribed, then analyzed using flexible coding, integrating inductive and deductive coding, to inform analytic code development and identify themes. RESULTS We identified three main themes around implementation of STOP act mandated prescribing limits: organizational communication, prescriber education, and changes in the electronic medical record (EMR) systems. Administrators reflected on implementation in the context of raising awareness and providing reminders to facilitate changes in prescriber behavior, operationalized through email and in-person communications as well as dedicated resources to EMR changes. Prescribers noted administrative communications about prescribing limits often focused on legality, suggesting a directive of the organization's policy rather than a passive reminder. Prescribers expressed a desire for more spaces to have their questions answered and resources for patient communications. While hospital administrators viewed compliance with the law as a priority, prescribers reflected on concerns for adequately managing their patients' pain and limited time for clinical care. CONCLUSIONS Hospital administrators and prescribers approached implementation of the STOP act prescribing limits with different mindsets. While administrators were focused on policy compliance, prescribers were focused on their patients' needs. Strategies to implement the mandate then had to balance patient needs with policy compliance. As states continue to legislate to prevent opioid overdose deaths, understanding how laws are implemented by healthcare systems and prescribers will improve their effectiveness through tailoring and maximizing available resources.
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Affiliation(s)
- Natalie A Blackburn
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA.
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Elizabeth Joniak-Grant
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
| | - Maryalice Nocera
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
| | - Samantha Wooten Dorris
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
| | - Nabarun Dasgupta
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
- Office of Research, Innovations, and Global Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul R Chelminski
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Timothy S Carey
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Health Center for Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - David A Edwards
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen W Marshall
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shabbar I Ranapurwala
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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