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Yun DH, Plymale MA, Oyler DR, Slavova SS, Davenport DL, Roth JS. Predictors of postoperative opioid use in ventral and incisional hernia repair. Surg Endosc 2024:10.1007/s00464-024-10808-9. [PMID: 38609586 DOI: 10.1007/s00464-024-10808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/21/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND One in two ventral and incisional hernia repair (VIHR) patients have preoperative opioid prescription within a year before procedure. The study's aim was to investigate risk factors of increased postoperative prescription filling in patients with or without preoperative opioid prescription. METHODS VIHR cases from 2013 to 2017 were reviewed. State prescription drug monitoring program data were linked to patient records. The primary endpoint was cumulative opioid dose dispensed through post-discharge day 45. Morphine milligram equivalent (MME) was used for uniform comparison. RESULTS 205 patients were included in the study (average age 53.5 years; 50.7% female). Over 35% met criteria for preoperative opioid use. Preoperative opioid tolerance, superficial wound infection, current smoking status, and any dispensed opioids within 45 days of admission were independent predictors for increased postoperative opioid utilization (p < 0.001). CONCLUSION Preoperative opioid use during 45-day pre-admission correlated strongly with postoperative prescription filling in VIHR patients, and several independent risk factors were identified.
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Affiliation(s)
- Do Hyun Yun
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Margaret A Plymale
- Division of General, Endocrine and Metabolic Surgery, Department of Surgery, University of Kentucky, 800 Rose Street, C-240, Lexington, KY, 40536, USA
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Svetla S Slavova
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Daniel L Davenport
- Department of Surgery, Division of Healthcare Outcomes and Optimal Patient Services, University of Kentucky, Lexington, KY, USA
| | - John Scott Roth
- Division of General, Endocrine and Metabolic Surgery, Department of Surgery, University of Kentucky, 800 Rose Street, C-240, Lexington, KY, 40536, USA.
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Oyler DR, Westgate PM, Walsh SL, Dolly Prothro J, Miller CS, Roberts MF, Freeman PR, Knudsen HK, Lang M, Dominguez-Fernandez E, Rojas-Ramirez MV. Alternatives to dental opioid prescribing after tooth extraction (ADOPT): protocol for a stepped wedge cluster randomized trial. BMC Oral Health 2024; 24:414. [PMID: 38575929 PMCID: PMC10996080 DOI: 10.1186/s12903-024-04201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Dentists and oral surgeons are leading prescribers of opioids to adolescents and young adults (AYA), who are at high risk for developing problematic opioid use after an initial exposure. Most opioids are prescribed after tooth extraction, but non-opioid analgesics provide similar analgesia and are recommended by multiple professional organizations. METHODS This multi-site stepped wedge cluster-randomized trial will assess whether a multicomponent behavioral intervention can influence opioid prescribing behavior among dentists and oral surgeons compared to usual practice. Across up to 12 clinical practices (clusters), up to 33 dentists/oral surgeons (provider participants) who perform tooth extractions for individuals 12-25 years old will be enrolled. After enrollment, all provider participants will receive the intervention at a time based on the sequence to which their cluster is randomized. The intervention consists of prescriber education via academic detailing plus provision of standardized patient post-extraction instructions and blister packs of acetaminophen and ibuprofen. Provider participants will dispense the blister packs and distribute the patient instructions at their discretion to AYA undergoing tooth extraction, with or without additional analgesics. The primary outcome is a binary, patient-level indicator of electronic post-extraction opioid prescription. Data for the primary outcome will be collected from the provider participant's electronic health records quarterly throughout the study. Provider participants will complete a survey before and approximately 3 months after transitioning into the intervention condition to assess implementation outcomes. AYA patients undergoing tooth extraction will be offered a survey to assess pain control and satisfaction with pain management in the week after their extraction. Primary analyses will use generalized estimating equations to compare the binary patient-level indicator of being prescribed a post-extraction opioid in the intervention condition compared to usual practice. Secondary analyses will assess provider participants' perceptions of feasibility and appropriateness of the intervention, and patient-reported pain control and satisfaction with pain management. Analyses will adjust for patient-level factors (e.g., sex, number of teeth extracted, etc.). DISCUSSION This real-world study will address an important need, providing information on the effectiveness of a multicomponent intervention at modifying dental prescribing behavior and reducing opioid prescriptions to AYA. CLINICALTRIALS GOV: NCT06275191.
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Affiliation(s)
- Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, 760 Press Avenue, Ste. 260, Lexington, KY, 40536, USA.
| | - Philip M Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jennifer Dolly Prothro
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, 760 Press Avenue, Ste. 260, Lexington, KY, 40536, USA
| | - Craig S Miller
- Department of Oral Diagnosis, Medicine, and Radiology, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - Monica F Roberts
- Substance Use Priority Research Area, University of Kentucky, Lexington, KY, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, 760 Press Avenue, Ste. 260, Lexington, KY, 40536, USA
| | - Hannah K Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Maggie Lang
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Enif Dominguez-Fernandez
- Department of Oral Health Science, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - Marcia V Rojas-Ramirez
- Department of Oral Diagnosis, Medicine, and Radiology, College of Dentistry, University of Kentucky, Lexington, KY, USA
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Foster JA, Hawk GS, Landy DC, Griffin JT, Bernard AC, Oyler DR, Southall WGS, Muhammad M, Sierra-Arce CR, Mounce SD, Borgida JS, Xiang L, Aneja A. Does Scheduled Low-Dose Short-Term NSAID (Ketorolac) Modulate Cytokine Levels Following Orthopaedic Polytrauma? A Secondary Analysis of a Randomized Clinical Trial. J Orthop Trauma 2024:00005131-990000000-00357. [PMID: 38506517 DOI: 10.1097/bot.0000000000002807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES To determine whether scheduled low-dose, short-term ketorolac modulates cytokine concentrations in orthopaedic polytrauma patients. METHODS DESIGN Secondary analysis of a double-blinded, randomized controlled trial. SETTING Single Level I trauma center from August 2018 to October 2022. PATIENT SELECTION CRITERIA Orthopaedic polytrauma patients between 18-75 years with a New Injury Severity Score greater than 9 were enrolled. Participants were randomized to receive 15 mg of intravenous (IV) ketorolac every 6 hours for up to 5 inpatient days or 2 mL of IV saline similarly. OUTCOME MEASURES AND COMPARISONS Daily concentrations of prostaglandin E2 (PGE2), interleukin (IL)-1a, IL-1b, IL-6, and IL-10. Clinical outcomes included hospital and intensive care unit (ICU) length of stay (LOS), pulmonary complications, and acute kidney injury (AKI). RESULTS Seventy orthopaedic polytrauma patients were enrolled, with 35 participants randomized to the ketorolac group and 35 to the placebo group. The overall IL-10 trend over time was significantly different in the ketorolac group (p = 0.043). IL-6 was 65.8% higher at enrollment compared to Day 3 (p < 0.001) when aggregated over both groups. There was no significant treatment effect for PGE2, IL-1a, or IL-1b (p > 0.05). There were no significant differences in clinical outcomes between groups (p > 0.05). CONCLUSIONS Scheduled low-dose, short-term, IV ketorolac was associated with significantly different mean trends in IL-10 concentration in orthopaedic polytrauma patients with no significant differences in PGE2, IL-1a, IL-1b, or IL-6 levels between groups. The treatment did not have an impact on clinical outcomes of hospital or ICU LOS, pulmonary complications, or AKI. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jeffrey A Foster
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Gregory S Hawk
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, KY
| | | | - Jarod T Griffin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Andrew C Bernard
- Department of Trauma and Acute Care Surgery, University of Kentucky, Lexington, KY
| | - Douglas R Oyler
- Pharmacy Practice & Science Department, University of Kentucky, Lexington, KY
| | - Wyatt G S Southall
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY
| | - Maaz Muhammad
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Samuel D Mounce
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY
| | - Jacob S Borgida
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Lusha Xiang
- US Army Institute of Surgical Research, San Antonio, TX
| | - Arun Aneja
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
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Oyler DR, Knudsen HK, Oser CB, Walsh SL, Roberts M, Nigam SR, Westgate PM, Freeman PR. Equity of overdose education and naloxone distribution provided in the Kentucky HEALing Communities Study. Drug Alcohol Depend Rep 2024; 10:100207. [PMID: 38283913 PMCID: PMC10821613 DOI: 10.1016/j.dadr.2023.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/09/2023] [Accepted: 11/20/2023] [Indexed: 01/30/2024]
Abstract
Background Opioid overdoses differentially affect demographic groups. Strategies to reduce overdose deaths, specifically overdose education and naloxone distribution (OEND), are not consistently delivered equitably. Methods The HEALing Communities StudySM (HCS) is a cluster-randomized trial designed to implement evidence-based practices, including OEND, to reduce overdose deaths across communities. Individuals receiving OEND in eight Kentucky counties between January 2020 and June 2022 provided demographics and overdose history. Recipient characteristics were compared to opioid overdose decedent characteristics to evaluate whether OEND was equitably delivered to the target population. Recipient characteristics were also analyzed based on whether OEND was delivered in criminal justice, behavioral health, or health care facilities. Results A total of 26,273 demographic records were analyzed from 137 partner agencies. Most agencies were in behavioral health (85.6 %) or criminal justice sectors (10.4 %). About half of OEND recipients were male (50.6 %), which was significantly lower than the 70.3 % of overdose decedents who were male, (p<0.001). OEND recipients tended to be younger than overdose decedents, but there were not significant differences in race/ethnicity between OEND recipients and overdose decedents. Over 40 % of OEND recipients had overdosed, and 68.9 % had witnessed a prior overdose. There were notable differences across facility types, as males and Black individuals accounted for fewer OEND recipients in addiction treatment facilities compared to jails. Conclusion Although OEND recipients' demographics resembled those of decedents, specific attention should be paid to ensuring equitable OEND access. Variation in OEND uptake by facility type may reflect biases and barriers to care.
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Affiliation(s)
- Douglas R. Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Carrie B. Oser
- Department of Sociology and Center on Drug and Alcohol Research, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Sharon L. Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Monica Roberts
- Substance Use Priority Research Area, University of Kentucky, Lexington, KY, USA
| | - Shawn R. Nigam
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Philip M. Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Patricia R. Freeman
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
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Knudsen HK, Freeman PR, Oyler DR, Oser CB, Walsh SL. Scaling up overdose education and naloxone distribution in Kentucky: adoption and reach achieved through a "hub with many spokes" model. Addict Sci Clin Pract 2023; 18:72. [PMID: 38031180 PMCID: PMC10688494 DOI: 10.1186/s13722-023-00426-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Scaling up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, in communities remains a challenge. Novel models and intentional implementation strategies are needed. Drawing upon the EPIS model's phases of Exploration, Preparation, Implementation, and Sustainment (Aarons et al. in Adm Policy Ment Health 38:4-23, 2011), this paper describes the development of the University of Kentucky's unique centralized "Naloxone Hub with Many Spokes" approach to implementing OEND as part of the HEALing Communities Study (HCS-KY). METHODS To scale up OEND in eight Kentucky counties, implementation strategies were utilized at two levels: a centralized university-based naloxone dispensing unit ("Naloxone Hub") and adopting organizations ("Many Spokes"). Implementation strategies varied across the EPIS phases, but heavily emphasized implementation facilitation. The Naloxone Hub provided technical assistance, overdose education resources, and no-cost naloxone to partner organizations. Implementation outcomes across the EPIS phases were measured using data from internal study management trackers and naloxone distribution data submitted by partner organizations. RESULTS Of 209 organizations identified as potential partners, 84.7% (n = 177) engaged in the Exploration/Preparation phase by participating in an initial meeting with an Implementation Facilitator about the HCS-KY OEND program. Adoption of the HCS-KY OEND program, defined as receipt of at least one shipment of naloxone, was achieved with 69.4% (n = 145) of all organizations contacted. During the Implementation phase, partner organizations distributed 40,822 units of naloxone, with partner organizations distributing a mean of 281.5 units of naloxone (SD = 806.2). The mean number of units distributed per county was 5102.8 (SD = 3653.3; range = 1057 - 11,053) and the mean county level distribution rate was 8396.5 units per 100,000 residents (SD = 8103.1; range = 1709.5-25,296.3). Of the partner organizations that adopted the HCS-KY OEND program, 87.6% (n = 127) attended a sustainability meeting with an Implementation Facilitator and agreed to transition to the state-funded naloxone program. CONCLUSIONS These data demonstrate the feasibility of this "Hub with Many Spokes" model for scaling up OEND in communities highly affected by the opioid epidemic. Trial registration ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939 .
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA.
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science and Center for the Advancement of Pharmacy Practice, College of Pharmacy, University of Kentucky, Lexington, KY, 40536, USA
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, 40536, USA
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, and Center for Health Equity Transformation, University of Kentucky, Lexington, KY, 40536, USA
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA
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Marks KR, Oyler DR, Strickland JC, Jaggers J, Roberts MF, Miracle DK, Barnes C, Lei F, Smith A, Mackin E, Martin MC, Freeman PR. Bystander preference for naloxone products: a field experiment. Harm Reduct J 2023; 20:171. [PMID: 38017424 PMCID: PMC10685501 DOI: 10.1186/s12954-023-00904-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Bystander administration of naloxone is a critical strategy to mitigate opioid overdose mortality. To ensure bystanders' willingness to carry and administer naloxone in response to a suspected overdose, it is critical to select products for community distribution with the highest likelihood of being utilized. This study examines bystanders' preference for and willingness to administer three naloxone products approved by the FDA for bystander use and identify product features driving preference. METHODS The population was a convenience sample of individuals who attended the Kentucky State Fair, August 18-28, 2022, in Louisville, Kentucky. Participants (n = 503) watched a standardized overdose education and naloxone training video, rated their willingness to administer each of three products (i.e., higher-dose nasal spray, lower-dose nasal spray, intramuscular injection), selected a product to take home, and rated factors affecting choice. RESULTS After training, 44.4% chose the higher-dose nasal spray, 30.1% chose the intramuscular injection, and 25.5% chose the lower-dose nasal spray. Factors most influencing choice on a 10-point Likert scale were ease of use (9 [7-10]), naloxone dose (8 [5-10]), and product familiarity (5 [5-9]). CONCLUSIONS Bystanders expressed high willingness to administer all studied formulations of naloxone products. Product choice preference varied as a function of product features. As the number and variety of available products continue to increase, continuous evaluation of formulation acceptability, in addition to including individuals with lived experience who are receiving and administering overdose reversal agents, is critical to support adoption and save lives.
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Affiliation(s)
- Katherine R Marks
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA.
- Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services, 275 E. Main Street, Frankfort, KY, 40621, USA.
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jody Jaggers
- Kentucky Pharmacy Education and Research Foundation, Frankfort, KY, USA
| | - Monica F Roberts
- Substance Use Priority Research Area, University of Kentucky, Lexington, KY, USA
| | - Dustin K Miracle
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Chase Barnes
- Kentucky Department for Public, Health Division of Public Health Protection & Safety, Frankfort, KY, USA
| | - Feitong Lei
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Amanda Smith
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Eric Mackin
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Martika C Martin
- Kentucky Pharmacy Education and Research Foundation, Frankfort, KY, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
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Freeman PR, McAninch J, Dasgupta N, Oyler DR, Slavov K, Collins C, Hargrove S, Freeman E, Miracle D, Slavova S. Drugs involved in Kentucky drug poisoning deaths and relation with antecedent controlled substance prescription dispensing. Subst Abuse Treat Prev Policy 2023; 18:53. [PMID: 37658455 PMCID: PMC10474700 DOI: 10.1186/s13011-023-00561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The shift from prescription to illicit drugs involved in drug poisoning deaths raises questions about the current utility of prescription drug monitoring program (PDMP) data to inform drug poisoning (overdose) prevention efforts. In this study, we describe relations between specific drugs involved in Kentucky drug poisoning deaths and antecedent controlled substance (CS) dispensing. METHODS The study used linked death certificates and PDMP data for 2,248 Kentucky resident drug poisoning deaths in 2021. Death certificate literal text analysis identified drugs mentioned with involvement (DMI) in drug poisoning deaths. We characterized the concordance between each DMI and the CS dispensing history for this drug at varying timepoints since 2008. RESULTS Overall, 25.5% of all decedents had dispensed CS in the month before fatal drug poisoning. Over 80% of decedents were dispensed opioid(s) since 2008; the percentage was similar regardless of opioid involvement in the poisoning death. One-third of decedents had dispensed buprenorphine for treatment of opioid use disorder since 2008, but only 6.1% had dispensed buprenorphine in the month preceding death. Fentanyl/fentanyl analogs were DMI in 1,568 (69.8%) deaths, yet only 3% had received a fentanyl prescription since 2008. The highest concordance in the month preceding death was observed for clonazepam (43.6%). CONCLUSION Overall, concordance between CS dispensing history and the drugs involved in poisoning deaths was low, suggesting a need to reevaluate the complex relationships between prescription medication exposure and overdose death and to expand harm reduction interventions both within and outside the healthcare system to reduce drug poisoning mortality.
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Affiliation(s)
- Patricia R Freeman
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA.
| | - Jana McAninch
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Nabarun Dasgupta
- Injury Prevention Research Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Krassimir Slavov
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Candice Collins
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Sarah Hargrove
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
| | - Edward Freeman
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Dustin Miracle
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
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Oyler DR, Rojas-Ramirez MV, Nakamura A, Quesinberry D, Miller CS. Dental opioid prescription patterns in academic and community settings. J Public Health Dent 2023. [PMID: 36905202 DOI: 10.1111/jphd.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/12/2022] [Accepted: 02/08/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVES Reports of interventions to improve dental opioid prescribing have come primarily from academic settings, but most opioid prescriptions are written by community dentists. This analysis compares prescription characteristics between these two groups to inform interventions to improve dental opioid prescribing in community settings. METHODS State prescription drug monitoring program data from 2013 to 2020 were used to compare opioid prescriptions from dentists at academic institutions (PDAI) to prescriptions from dentists in non-academic settings (PDNS). Linear regression was used to assess daily morphine milligram equivalents (MME), total MME, and days' supply, adjusting for year, age, sex, and rurality. RESULTS Prescriptions from dentists at the academic institution accounted for less than 2% of over 2.3 million dental opioid prescriptions analyzed. Over 80% of prescriptions in both groups were written for <50 MME per day and for ≤3 days' supply. On average, in the adjusted models, prescriptions from the academic institution were written for about 75 additional MME per prescription and nearly a full day longer duration. Compared to adults, adolescents were the only age group who received both higher daily doses and longer days' supply. CONCLUSIONS Prescriptions from dentists at academic institutions accounted for small percentage of opioid prescriptions, but prescription characteristics were clinically comparable between groups. Interventional targets to reduce opioid prescribing in academic institutions could be applied to community settings.
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Affiliation(s)
- Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Marcia V Rojas-Ramirez
- Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
| | - Aisaku Nakamura
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Dana Quesinberry
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA.,Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Craig S Miller
- Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
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Olney WJ, Johnson EG, Potts C, Murphy JT, Oyler DR. Continuing Chronic Buprenorphine Perioperatively is Associated With Reduced Postoperative Opioid Use. J Surg Res 2023; 281:63-69. [PMID: 36116209 DOI: 10.1016/j.jss.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/14/2022] [Accepted: 08/11/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Buprenorphine is a frequently used medication for opioid use disorder and misunderstanding buprenorphine's unique pharmacology has historically complicated perioperative analgesia. The purpose of this study was to evaluate the association of perioperative buprenorphine continuation in patients with substance use disorder on perioperative opioid use. MATERIALS AND METHODS This was a single-center retrospective study at a level 1 trauma academic medical center. Adult patients using outpatient buprenorphine for medication for opioid use disorder admitted with an operating room booking were included. Patients were grouped (continuation, withheld) retrospectively based upon the decision to continue or omit buprenorphine therapy while admitted. The primary outcome of the study was any use of full mu-opioid agonists during days 1-7 of admission. Secondary outcomes included length of stay and average pain scores during days 1-7 of admission. RESULTS 43.4% of patients in the continuation cohort used no full mu-opioid agonists during days 1-7 compared to 3.1% of patients in the withheld cohort (P < 0.001). No significant difference in median length of stay was noted (4.7 d [2.8-6.6] versus 6.1 d [4.0-8.2], P = 0.36). There was no statistical difference in average pain scores on postoperative days 1 (5.2 versus 6.9, P = 0.82) and 7 (0 versus 0, P = 0.41). CONCLUSIONS Perioperative continuation of buprenorphine is associated with reduced use of alternative full mu-opioid agents while admitted without impacting pain scores.
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Affiliation(s)
- William J Olney
- Department of Pharmacy, University of Kentucky Medical Center, Lexington, Kentucky.
| | - Eric G Johnson
- Department of Pharmacy, University of Kentucky Medical Center, Lexington, Kentucky; University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Cassidy Potts
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - J Thomas Murphy
- Department of Anesthesiology, University of Kentucky Medical Center, Lexington, Kentucky; University of Kentucky College of Medicine, Lexington, Kentucky
| | - Douglas R Oyler
- University of Kentucky College of Pharmacy, Lexington, Kentucky
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Oyler DR, Slavova S, Freeman PR, Huang Z, Talbert J, Walsh SL, Westgate PM. Broadband internet subscription rates and opioid prescribing via telemedicine during the COVID-19 pandemic. J Rural Health 2022; 38:900-907. [PMID: 35224768 PMCID: PMC9115233 DOI: 10.1111/jrh.12653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE In response to the COVID-19 pandemic, the US DEA allowed controlled substance prescriptions to be issued following a telemedicine encounter. This study evaluated changes in opioid prescribing in Kentucky counties with low and high rates of broadband subscription before, during, and after a series of statewide emergency declarations that may have affected health care access. METHODS The study used the prescription drug monitoring program to analyze records of opioid analgesic prescriptions dispensed to opioid-naïve individuals in high (N = 26) and low (N = 94) broadband access counties during 3 periods: before a state of emergency (SOE) and executive order (EO) limiting nonemergent health care services (January 2019-February 2020), while the EO was active (March-April 2020), and after health care services began reopening (May-December 2020). Marginal generalized estimating equations-type negative binomial models were fit to compare prescription counts by broadband access over the 3 periods. FINDINGS Rates of opioid dispensing to opioid-naïve individuals decreased significantly during the EO, but increased nearly to pre-SOE levels after health care services began reopening. Dispensing rates in low broadband counties were higher than those in high broadband counties during all time periods, although these differences were negligible after adjusting for potential confounders. During the EO, prescriptions were written for longer days' supply in both county types. CONCLUSIONS The overall dramatic reduction in opioid prescribing rates should be considered when evaluating annual opioid prescribing trends. However, broadband subscription rate did not appear to influence opioid prescriptions dispensed in Kentucky during the EO.
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Affiliation(s)
- Douglas R. Oyler
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky, USA
| | - Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Patricia R. Freeman
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky, USA
| | - Zhengyan Huang
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Jeffery Talbert
- Department of Biomedical Informatics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Sharon L. Walsh
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Philip M. Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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Oyler DR, Rojas-Ramirez MV, Nakamura A, Quesinberry D, Bernard P, Surratt H, Miller CS. Factors influencing opioid prescribing after tooth extraction. J Am Dent Assoc 2022; 153:868-877. [PMID: 35691709 DOI: 10.1016/j.adaj.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tooth extractions account for most opioid prescriptions from dentists, but specific characteristics that influence likelihood are less established. Improving understanding can facilitate development of tailored interventions to reduce unnecessary opioid prescribing. METHODS The authors performed a retrospective review of patients 12 years and older undergoing tooth extraction at the College of Dentistry at the University of Kentucky from 2013 through 2020. The primary end point was issuance of an opioid prescription related to the encounter. RESULTS In 44,387 eligible records analyzed, 10,628 (23.9%) patients received an opioid prescription. Results of multivariable logistic regression found that the factors associated with an opioid prescription included receipt of a nonopioid analgesic prescription (adjusted odds ratio [aOR], 11.36; 95% CI, 10.37 to 12.44), receipt of an antibiotic prescription (aOR, 8.29; 95% CI, 7.57 to 9.08), procedural sedation (aOR, 2.11; 95% CI, 1.93 to 2.31), surgical extraction (aOR, 1.96; 95% CI, 1.84 to 2.10), and third molar extractions (1 tooth: aOR, 1.14; 95% CI 1.04 to 1.25; 2 teeth: aOR, 2.09; 95% CI, 2.87 to 2.34; 3 teeth: aOR, 2.73; 95% CI, 2.36 to 3.15; 4 teeth: aOR, 3.45; 95% CI, 3.10 to 3.83). Factors that decreased risk included having an appointment in 2018 or later (aOR, 0.31; 95% CI, 0.29 to 0.33), in a student (aOR, 0.57; 95% CI, 0.51 to 0.65) or resident (aOR, 0.33; 95% CI, 0.31 to 0.36) clinic, and on any day other than Friday (Monday: aOR, 0.83; 95% CI, 0.76 to 0.91; Tuesday: aOR, 0.90; 95% CI, 0.83 to 0.99; Wednesday: aOR, 0.89; 95% CI, 0.81 to 0.97; Thursday: aOR, 0.88; 95% CI 0.81 to 0.97). CONCLUSIONS Opioid prescriptions after tooth extraction were common in patients undergoing more extensive procedures. Provider perceptions, habits, and several clinical factors appeared to influence prescribing patterns. PRACTICAL IMPLICATIONS The decision to prescribe an opioid appears to be associated with habits and factors perceived to modulate postoperative pain, which may serve as targets for opioid reduction strategies.
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Walker DM, Childerhose JE, Chen S, Coovert N, Jackson RD, Kurien N, McAlearney AS, Volney J, Alford DP, Bosak J, Oyler DR, Stinson LK, Behrooz M, Christopher MC, Drainoni ML. Exploring perspectives on changing opioid prescribing practices: A qualitative study of community stakeholders in the HEALing Communities Study. Drug Alcohol Depend 2022; 233:109342. [PMID: 35151024 PMCID: PMC8957585 DOI: 10.1016/j.drugalcdep.2022.109342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Community-based perspectives are needed to more broadly inform policy-makers, public health practitioners, prescribers, and pharmacists about community-led and broader efforts to reduce opioid overprescribing, and ultimately reduce prescription opioid use disorder, overdoses and fatalities. The aim of this study is to explore community-based perspectives on efforts to change opioid prescribing practices in their communities. METHODS Semi-structured interviews were conducted with 388 community stakeholders across four states (Kentucky, Massachusetts, New York, Ohio) from November 2019 to January 2020 about community approaches and goals of community-led responses to the opioid crisis. Data analysis combined deductive and inductive approaches to identify themes and sub-themes related to improving opioid prescribing practices. RESULTS Three major themes and different subthemes were characterized: (1) acknowledging progress (i.e., healthcare providers being part of the solution, provider education, and prescription drug monitoring programs); (2) emergent challenges (i.e., physician nonadherence with safer opioid prescribing guidelines, difficulty identifying appropriate use of opioids, and concerns about accelerating the progression from opioid misuse to drug abuse); and (3) opportunities for change (i.e., educating patients about safer use and proper disposal of opioids, expanding prescriber and pharmacist education, changing unrealistic expectations around eliminating pain, expanding and increasing insurance coverage for alternative treatment options). CONCLUSIONS Community stakeholders appeared to support specific opportunities to reduce prescription opioid misuse and improve safer prescribing. The opportunities included culture change around pain expectations, awareness of safe disposal, additional provider education, and increased coverage and acceptability of non-opioid treatments.
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Affiliation(s)
- Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 460 Medical Center Dr., Suite 530, Columbus, OH, 43210, USA,CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Janet E. Childerhose
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA,Department of Internal Medicine, College of Medicine, The Ohio State University, Martha Morehouse Pavilion, 2050 Kenny Road, Suite 2428, Columbus, OH, 43221, USA
| | - Sadie Chen
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Nicolette Coovert
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Rebecca D. Jackson
- Center for Clinical and Translational Science and the Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University, 376 W. 10 Ave, Suite 205, Columbus, OH, 43210, USA
| | - Natasha Kurien
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 460 Medical Center Dr., Suite 530, Columbus, OH, 43210, USA,CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Jaclyn Volney
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA
| | - Daniel P. Alford
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Rm 2060, Boston, MA, 02118, USA
| | - Julie Bosak
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Rm 2060, Boston, MA, 02118, USA
| | - Douglas R. Oyler
- Pharmacy Practice and Science Department, College of Pharmacy, University of Kentucky, 780 S. Limestone, Lee T. Todd, Jr. Bldg, Rm 285, Lexington, KY, 40506, USA
| | - Laura K. Stinson
- Pharmacy Practice and Science Department, College of Pharmacy, University of Kentucky, 780 S. Limestone, Lee T. Todd, Jr. Bldg, Rm 285, Lexington, KY, 40506, USA
| | - Melika Behrooz
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Mia-Cara Christopher
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Mari-Lynn Drainoni
- Boston Medical Center and Boston University School of Medicine, Boston, MA, 801 Massachusetts Ave, Rm 2014, Boston, MA, 02118, USA
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Leader PW, Oyler DR, Carter TM, Damron DS, Lee CY, Sloan DA, Inabnet WB, Randle RW. Opioid-Free Thyroid and Parathyroid Operations: Are Patients Satisfied With Pain Control? Am Surg 2021:31348211048846. [PMID: 34732084 DOI: 10.1177/00031348211048846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to evaluate pain control and patient satisfaction using an opioid-free analgesic regimen following thyroid and parathyroid operations. METHODS Surveys were distributed to all postoperative patients following total thyroidectomy, thyroid lobectomy, and parathyroidectomy between January and April 2020. After surgery, patients were discharged without opioids except in rare cases based on patient needs and surgeon judgment. We measured patient-reported Numeric Rating Scale (NRS) pain scores and satisfaction categorically as either satisfied or dissatisfied. RESULTS We received 90 of 198 surveys distributed, for a 45.5% response rate. After excluding neck dissections (n = 6) and preoperative opioid use (n = 4), the final cohort included 80 patients after total thyroidectomy (26.3%), thyroid lobectomy (41.3%), and parathyroidectomy (32.5%).The majority reported satisfaction with pain control (87.5%) and the entire surgical experience (95%). A similar proportion of patients reported satisfaction with pain control after total thyroidectomy (90.9%), thyroid lobectomy (90.5%), and parathyroidectomy (80.8%), indicating the procedure did not significantly impact satisfaction with pain control (P = .47). Patients who reported dissatisfaction with pain control were more likely to receive opioid prescriptions (30% vs 2.9%, P < .01), but the majority still reported satisfaction with their entire operative experience (70%). DISCUSSION Even with an opioid-free postoperative pain regimen, most patients report satisfaction with pain control after thyroid and parathyroid operations, and those who were dissatisfied with their pain control generally reported satisfaction with their overall surgical experience. Therefore, an opioid-free postoperative pain control regimen is well tolerated and unlikely to decrease overall patient satisfaction.
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Affiliation(s)
- Preston W Leader
- Department of Otolaryngology, 4530University of Kentucky College of Medicine, Lexington, KY, USA
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, 12252University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Tonya M Carter
- Department of Surgery, 12252University of Kentucky College of Medicine, Lexington, KY, USA
| | - Donna S Damron
- Department of Surgery, 12252University of Kentucky College of Medicine, Lexington, KY, USA
| | - Cortney Y Lee
- Department of Surgery, 12252University of Kentucky College of Medicine, Lexington, KY, USA
| | - David A Sloan
- Department of Surgery, 12252University of Kentucky College of Medicine, Lexington, KY, USA
| | - William B Inabnet
- Department of Surgery, 12252University of Kentucky College of Medicine, Lexington, KY, USA
| | - Reese W Randle
- Department of General Surgery, 528756Wake Forest Baptist Health, Winston-Salem, NC, USA
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Mirtsching DS, Movilla PR, Oyler DR, Hoffman MR. Post-Operative Opioid Use with a Modified ERAS Protocol: A before-and-after Comparison. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Dittmer SJ, Davenport DL, Oyler DR, Bernard AC. The Influence of the Opioid Epidemic on Firearm Violence in Kentucky Counties. J Surg Res 2021; 264:186-193. [PMID: 33838402 DOI: 10.1016/j.jss.2021.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/26/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The opioid crisis is a major public health emergency. Current data likely underestimate the full impact on mortality due to limitations in reporting and toxicology screening. We explored the relationship between opioid overdose and firearm-associated emergency department visits (ODED & FAED, respectively). METHODS For the years 2010 to 2017, we analyzed county-level ODED and FAED visits in Kentucky using Office of Health Policy and US Census Bureau data. Firearm death certificate data were analyzed along with high-dose prescriptions from the Kentucky All Schedule Prescription Electronic Reporting records. Socioeconomic variables analyzed included health insurance coverage, race, median household earnings, unemployment rate, and high-school graduation rate. RESULTS ODED and FAED visits were correlated (Rho = 0.29, P< 0.01) and both increased over the study period, remarkably so after 2013 (P < 0.001). FAED visits were higher in rural compared to metro counties (P < 0.001), while ODED visits were not. In multivariable analysis, FAED visits were associated with ODED visits (Std. B = 0.24, P= 0.001), high-dose prescriptions (0.21, P = 0.008), rural status (0.19, P = 0.012), percentage white race (-0.28, P = 0.012), and percentage high school graduates (-0.68, P < 0.001). Unemployment and earnings were bivariate correlates with FAED visits (Rho = 0.42, P < 0.001 and -0.32, P < 0.001, respectively) but were not significant in the multivariable model. CONCLUSIONS In addition to recognized nonfatal consequences of the opioid crisis, firearm violence appears to be a corollary impact, particularly in rural counties. Firearm injury prevention efforts should consider the contribution of opioid use and abuse.
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Affiliation(s)
- Sarah J Dittmer
- University of Kentucky College of Medicine; Lexington, Kentucky
| | - Daniel L Davenport
- Department of Surgery, Division of Healthcare Outcomes and Optimal Patient Services, University of Kentucky, Lexington, Kentucky
| | - Douglas R Oyler
- University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, Lexington, Kentucky
| | - Andrew C Bernard
- Department of Surgery, Division of Acute Care Surgery, Trauma and Surgical Critical Care, University of Kentucky, Lexington, Kentucky.
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16
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Oyler DR, Miller CS. Patterns of opioid prescribing in an Appalachian college of dentistry. J Am Dent Assoc 2021; 152:209-214. [PMID: 33632410 DOI: 10.1016/j.adaj.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/11/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nonopioids provide sufficient analgesia with less risk after most dental procedures, but opioid prescriptions are still common. This study analyzed opioid prescribing characteristics on the basis of patient demographics and procedure types. METHODS The authors conducted a secondary analysis of an existing data set of opioid prescriptions issued from 2013 through 2018 from a college of dentistry in central Appalachia. Opioid prescriptions for young children or liquids were excluded. The authors analyzed prescriptions according to patient age group and sedation level required for surgical procedures. RESULTS Of 12,464 opioid prescriptions analyzed, 70% were written after extractions or surgical procedures. More than one-half (57.3%) were written for patients younger than 45 years. Adolescent and young adult (AYA) patients received prescriptions of higher quantities (mean [standard deviation], 20.9 [6.4] pills; 95% confidence interval, 20.6 to 21.1) and of longer durations (mean [standard deviation], 3.3 [1.5] days; 95% confidence interval, 3.2 to 3.4) than other groups (P < .001; 1-way analysis of variance). CONCLUSIONS AYA patients received more opioids than older patients after dental procedures, which is concerning given the high risk associated with AYA opioid exposure. Faculty in colleges of dentistry should educate students and residents on the risks and benefits of opioid therapy as well as alternative analgesics and via exemplifying appropriate prescribing behavior. PRACTICAL IMPLICATIONS AYA patients represent a seemingly unidentified high-risk age group for dentists. Dentists who perform invasive procedures must examine carefully opioid prescription necessity and prescribe in a manner consistent with best practices.
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Starr N, Oyler DR, Schadler A, Aouad RK. Chronic opioid use after laryngeal cancer treatment. Head Neck 2020; 43:1242-1251. [PMID: 33368718 DOI: 10.1002/hed.26591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/14/2020] [Accepted: 12/17/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Survivors of head and neck cancer may be at increased risk for chronic opioid use and questions remain about risk factors. METHODS Retrospective study of patients with laryngeal cancer prescribed opioids utilizing the Truven Health Marketscan database. Patients had laryngeal cancer, underwent treatment, filled an opioid prescription, and were enrolled in this private insurance plan 1 year prior to and after treatment. RESULTS In this study, 7484 patients were included; 17.2% developed chronic opioid use, defined as consecutive opioid fills at least 90 days after treatment cessation. Early opioid use (OR = 3.607, 95% CI [3.125-4.163]), tobacco use (OR = 1.28, 95% CI [1.117-1.467]), median morphine milligram equivalent (MME; OR = 1.001, 95% CI [1.000-1.0001]), and radiation alone (OR = 1.435, 95% CI [1.199-1.717]) were predictive of chronic opioid use. CONCLUSIONS Nearly one in five patients prescribed opioids during treatment developed chronic use. Providers should discuss the risk of chronic opioid use, set expectations for opioid weaning, and consider adjunct pain regimens to develop effective pain management strategies.
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Affiliation(s)
- Nicole Starr
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Douglas R Oyler
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Aric Schadler
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Rony K Aouad
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, Kentucky, USA
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18
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Flannery AH, Hammond DA, Oyler DR, Li C, Wong A, Smith AP, Yeo QM, Chaney W, Pfaff CE, Plewa-Rusiecki AM, Juang P. Vancomycin Dosing Practices among Critical Care Pharmacists: A Survey of Society of Critical Care Medicine Pharmacists. Infect Dis (Lond) 2020; 13:1178633720952078. [PMID: 33029073 PMCID: PMC7522823 DOI: 10.1177/1178633720952078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/02/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Critically ill patients and their pharmacokinetics present complexities often not considered by consensus guidelines from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Prior surveys have suggested discordance between certain guideline recommendations and reported infectious disease pharmacist practice. Vancomycin dosing practices, including institutional considerations, have not previously been well described in the critically ill patient population. Objectives To evaluate critical care pharmacists' self-reported vancomycin practices in comparison to the 2009 guideline recommendations and other best practices identified by the study investigators. Methods An online survey developed by the Research and Scholarship Committee of the Clinical Pharmacy and Pharmacology (CPP) Section of the Society of Critical Care Medicine (SCCM) was sent to pharmacist members of the SCCM CPP Section practicing in adult intensive care units in the spring of 2017. This survey queried pharmacists' self-reported practices regarding vancomycin dosing and monitoring in critically ill adults. Results Three-hundred and sixty-four responses were received for an estimated response rate of 26%. Critical care pharmacists self-reported largely following the 2009 vancomycin dosing and monitoring guidelines. The largest deviations in guideline recommendation compliance involve consistent use of a loading dose, dosing weight in obese patients, and quality improvement efforts related to systematically monitoring vancomycin-associated nephrotoxicity. Variation exists regarding pharmacist protocols and other practices of vancomycin use in critically ill patients. Conclusion Among critical care pharmacists, reported vancomycin practices are largely consistent with the 2009 guideline recommendations. Variations in vancomycin dosing and monitoring protocols are identified, and rationale for guideline non-adherence with loading doses elucidated.
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Affiliation(s)
| | | | | | - Chenghui Li
- University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA
| | | | | | - Qiu Min Yeo
- Department of Pharmacy, Changi General Hospital, Singapore
| | | | | | | | - Paul Juang
- St. Louis College of Pharmacy, St. Louis, MO, USA
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Atyia SA, Paloucek FP, Butts AR, Oyler DR, Martin CA, Schadler AD, Cook AM. Impact of PhORCAS references on overall application score for postgraduate year 1 pharmacy residency candidates. Am J Health Syst Pharm 2020; 77:1237-1242. [DOI: 10.1093/ajhp/zxaa152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
The disparity between the number of applicants for postgraduate year 1 (PGY1) pharmacy residency positions and the number of available residency positions increases the need to optimize how applicants are evaluated. The purpose of the study described here was to evaluate the correlation of ratings of residency candidate characteristics by academic and professional references listed on residency applications with overall application score, applicant ranking, and the likelihood of candidates receiving an invitation to interview.
Methods
A multicenter, retrospective study was conducted to evaluate the correlation of reference writers’ ratings of 13 candidate characteristics and their overall recommendations with program-determined outcomes (eg, final application score, applicant ranking, and invitation to interview) through analysis of PGY1 applications submitted through the Pharmacy Online Residency Centralized Application System (PhORCAS) from 2015 through 2018. Keywords and themes within the open-ended section of letters of reference were also analyzed for correlation with overall application score.
Results
A total of 5,923 references listed on 1,867 applications to 4 PGY1 pharmacy residency programs processed by PhORCAS were included in the analysis. For the majority of applicant characteristic ratings (ie, 74% of 56,872 ratings overall), reference writers rated candidates as exceeding expectations, and applicants were “highly recommended” by these evaluators in 91% of cases. References’ average characteristic ratings and overall recommendations were poorly correlated with final application score (R2 = 0.12 [P < 0.0001] and R2 = 0.08 [P < 0.0001], respectively), final ranking (R2 = 0.02 [P < 0.0001] and R2 = 0.03 [P < 0.0001], respectively), and invitation to interview (R2 = 0.07 [P < 0.0001] and R2 = 0.04 [P < 0.0001], respectively). For the themes evaluated, references’ use of teaching words best correlated with normalized final application score, although the correlation was poor (R2 = 0.007, P = 0.0001).
Conclusion
Reference writers’ ratings of PGY1 residency candidate characteristics in PhORCAS are poorly correlated with application score, applicant ranking, and invitation to interview. The results of this study suggest that the existing PhORCAS standardized form for submitting references is of limited utility in its current state.
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Affiliation(s)
- Sara A Atyia
- Department of Pharmacy, Ohio State University Wexner Medical Center, Columbus, OH
| | - Frank P Paloucek
- Department of Pharmacy Practice, University of Illinois Chicago, Chicago, IL
| | - Allison R Butts
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Douglas R Oyler
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Craig A Martin
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Aric D Schadler
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Aaron M Cook
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
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Troutman Adams E, Cohen EL, Bernard A, Darnell WH, Oyler DR. Can opioid vigilance and patient-centered care coexist? A qualitative study of communicative tensions encountered by surgical trainees. J Opioid Manag 2020; 16:91-101. [PMID: 32329884 DOI: 10.5055/jom.2020.0555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The American health care system's adoption of the patient-centered care (PCC) model has transformed how medical pro-viders communicate with patients about prescription pain medication. Concomitantly, the nation's opioid epidemic has necessitated a proactive response from the medical profession, requiring providers who frequently dispense opioids for acute pain to exercise vigi-lance in monitoring and limiting outpatient prescriptions. This qualitative study explores how surgical trainees balance PCC directives, including shared decision making, exchanging information with patients, and relationship maintenance, with opioid prescribing vigi-lance. DESIGN Investigators conducted interviews with 17 surgical residents and fellows (trainees) who routinely prescribe opioids at an ac-ademic medical center. RESULTS A qualitative descriptive analysis produced four codes, which were reduced to themes depicting problematic intersections between PCC imperatives and opioid vigilance during post-operative opioid-prescribing communication: (a) sharing the deci-sion-making process contended with exerting medical authority, (b) reciprocating information contended with negotiating opioid prescribing terms with patients, (c) maintaining symbiotic relationships contended with prescribing ethics, and (d) achieving patient satisfaction contended with safeguarding opioid medications. CONCLUSION Surgical training programs must supply trainees with post-surgical prescribing guidelines and communication skills training. Training should emphasize how PCC directives may work in tandem with-not in opposition to-opioid vigilance.
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Affiliation(s)
- Elizabeth Troutman Adams
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elisia L Cohen
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, Minnesota
| | - Andrew Bernard
- Department of Trauma and Surgery, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Whittney H Darnell
- College of Communication and Information, University of Kentucky, Lexington, Kentucky
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
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Affiliation(s)
- Douglas R Oyler
- Office of Opioid Safety and Department of Pharmacy Practice and Science University of Kentucky Lexington, KY
| | - Roland Short
- Inpatient Pain Service and Department of Anesthesiology and Perioperative Medicine University of Alabama at Birmingham Birmingham, AL
| | - Johnathan H Goree
- Chronic Pain Division and Department of Anesthesiology University of Arkansas for Medical Sciences Little Rock, AR
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Abstract
OBJECTIVE To evaluate current practices in naloxone prescribing upon hospital discharge. DESIGN Electronic cross-sectional survey. SETTING Academic medical center. PARTICIPANTS Inpatient physicians and advanced practice providers. MAIN OUTCOME MEASURES Respondents completed survey items including current naloxone prescribing practices, barriers to naloxone prescribing, and methods to improve naloxone prescribing. RESULTS The survey response rate was 51.6 percent. Greater than 90 percent of respondents agreed that naloxone should be prescribed for patients with an active opioid use disorder, history of overdose, and use of greater than 50 morphine milligram equivalents per day. Lack of patient education on proper use of naloxone was the most identified barrier to prescribing. CONCLUSIONS Providers agree with the Centers for Disease Control and Prevention recommendations to prescribe naloxone to high-risk patients. Certain barriers affect the rate of naloxone prescribing at discharge, including lack of time, patient education, provider training, and concern for increasing riskier behaviors.
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Affiliation(s)
- Michelle Punzal
- Department of Internal Medicine, Medstar Georgetown University Hospital, Washington, DC
| | - Patricia Santos
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Xiaoshu Li
- Center for Health Services Research, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Alan M Hall
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky; Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky
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Abstract
OBJECTIVE To examine attitudes, beliefs, and influencing factors of inpatient healthcare providers regarding prescription of opioid analgesics. DESIGN Electronic cross-sectional survey. SETTING Academic medical center. PARTICIPANTS Physicians, advanced practice providers, and pharmacists from a single academic medical center in the southeast United States. MAIN OUTCOME MEASURES Respondents completed survey items addressing: (1) their practice demographics, (2) their opinions regarding overall use, safety, and efficacy of opioids compared to other analgesics, (3) specific clinical scenarios, (4) main pressures to prescribe opioids, and (5) confidence/comfort prescribing opioids or nonopioids in select situations. RESULTS The majority of the sample (n = 363) were physicians (60.4 percent), with 69.4 percent of physicians being attendings. Most respondents believed that opioids were overused at our institution (61.7 percent); nearly half thought opioids had similar efficacy to other analgesics (44.1 percent), and almost all believed opioids were more dangerous than other analgesics (88.1 percent). Many respondents indicated that they would modify a chronic regimen for a high-risk patient, and use of nonopioids in specific scenarios was high. However, this use was often in combination with opioids. Respondents identified patients (64 percent) and staff (43.1 percent) as the most significant sources of pressure to prescribe opioids during an admission; the most common sources of pressure to prescribe opioids on discharge were to facilitate discharge (44.8 percent) and to reduce follow-up requests, calls, or visits (36.3 percent). Resident physicians appear to experience more pressure to prescribe opioids than other providers. Managing pain in patients with substance use disorders and effectively using nonopioid analgesics were the most common educational needs identified by respondents. CONCLUSION Most individuals believe opioid analgesics are overused in our specific setting, commonly to satisfy patient requests. In general, providers feel uncomfortable prescribing nonopioid analgesics to patients.
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Affiliation(s)
- Douglas R Oyler
- Office of Opioid Safety, University of Kentucky HealthCare, Lexington, Kentucky
| | - Kristy S Deep
- Division of Internal Medicine, University of Kentucky HealthCare, Lexington, Kentucky
| | - Phillip K Chang
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Kentucky HealthCare, Lexington, Kentucky
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Parli SE, Pfeifer C, Oyler DR, Magnuson B, Procter LD. Redefining “bowel regimen”: Pharmacologic strategies and nutritional considerations in the management of small bowel fistulas. Am J Surg 2018; 216:351-358. [DOI: 10.1016/j.amjsurg.2018.01.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/02/2017] [Accepted: 01/18/2018] [Indexed: 11/30/2022]
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Neff C, Totten C, Plymale M, Oyler DR, Davenport D, Roth JS. Associations between anxiolytic medications and ventral hernia repair. Hernia 2018; 22:753-757. [PMID: 29594842 DOI: 10.1007/s10029-018-1766-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/23/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examines the relationship between anxiolytic medications (AXM) on outcomes following ventral hernia repair. METHODS A single-center review of prospectively obtained perioperative and 30-day outcome data, including AXM use at admission, as part of the National Surgery Quality Improvement Program. RESULTS Sixty-three of the 393 patients who presented for ventral hernia repair were taking an AXM (15.6%). AXM users were more likely to have a higher ASA class, dyspnea, and treated hypertension (p < 0.05). AXM use was associated with increased operative duration, hernia size, increased estimated blood loss, and need for component separation. After adjusting for medical comorbidities, AXM users were not found to have greater 30-day morbidity or mortality. Patients taking AXM were found to have greater length of stay and increased hospital readmissions. CONCLUSIONS Patients taking anxiolytic medications undergoing ventral hernia repairs have higher ASA scores, more complex hernia characteristics, and require more concurrent procedures. They were found to have longer operative times, increased blood loss, greater duration of hospital stay, and increased readmissions that were associated with the increased perioperative risk factors. Further studies are required to determine causal links.
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Affiliation(s)
- C Neff
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - C Totten
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - M Plymale
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA.
| | - D R Oyler
- Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street, Lexington, KY, 40536, USA
| | - D Davenport
- Department of Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - J S Roth
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
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Johnson EG, Oyler DR. Introduction to surgical and perioperative clinical pharmacy for third-year pharmacy students: A pilot study of an elective course. Curr Pharm Teach Learn 2018; 10:285-290. [PMID: 29764631 DOI: 10.1016/j.cptl.2017.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 07/28/2017] [Accepted: 11/23/2017] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The objective of this study was to implement and assess an elective course that exposes pharmacy students to clinical pharmacy in the surgical and perioperative setting. METHODS A blended-design elective that included synchronous and asynchronous learning was developed and offered to third-year pharmacy students. Students' knowledge and perception regarding clinical topics in perioperative pharmacy was assessed using pre- and post-course assessments, online quizzes, a journal club, and course assignments. Knowledge of pharmacy operations was assessed using course assignments and reflective journal entries. RESULTS Pre- and post-course assessment improvement was seen in the categories of perioperative optimization of pharmacotherapy (29.1-70.1%, p=0.006), common surgical complications (45.8-91.7%, p = 0.001), and anesthetic agents (25-71.9%, p <0.001). Overall, the course was successful in increasing clinical pharmacy knowledge and was well received by students. Course evaluations were completed by 100% of students, and all rated the course as "excellent." Students demonstrated mastery of course content, though the course may not have provided optimal exposure to operating room/post-anesthesia care unit operations. DISCUSSION AND CONCLUSIONS Students agreed that the course was valuable and helped them develop new skills otherwise not developed by the curriculum; this conclusion was supported by objective assessment data. A team-teaching model allowed for minimal resources to operate the course. Moving forward, an early lecture addressing perioperative operations may supplement an area the course was lacking. Additionally, a longer duration of operating room shadowing may provide requested opportunities for observation of direct patient care.
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Affiliation(s)
- Eric G Johnson
- University of Kentucky College of Pharmacy, University of Kentucky HealthCare, Department of Pharmacy, Department of Pharmacy Services, H110, University of Kentucky HealthCare, 800 Rose Street, Lexington, KY 40536-0293, United States.
| | - Douglas R Oyler
- University of Kentucky College of Pharmacy, University of Kentucky HealthCare, Department of Pharmacy, Department of Pharmacy Services, H110, University of Kentucky HealthCare, 800 Rose Street, Lexington, KY 40536-0293, United States.
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Hammond DA, Oyler DR, Devlin JW, Painter JT, Bolesta S, Swanson JM, Bailey BJ, Branan T, Barletta JF, Dunn B, Haney JS, Juang P, Kane-Gill SL, Kiser TH, Shafeeq H, Skaar D, Smithburger P, Taylor J. Perceived Motivating Factors and Barriers for the Completion of Postgraduate Training Among American Pharmacy Students Prior to Beginning Advanced Pharmacy Practice Experiences. Am J Pharm Educ 2017; 81:90. [PMID: 28720918 PMCID: PMC5508089 DOI: 10.5688/ajpe81590] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/22/2016] [Indexed: 05/30/2023]
Abstract
Objective. To examine perceived motivating factors and barriers (MFB) to postgraduate training (PGT) pursuit among pharmacy students. Methods. Third-year pharmacy students at 13 schools of pharmacy provided demographics and their plan and perceived MFBs for pursuing PGT. Responses were characterized using descriptive statistics. Kruskal-Wallis equality-of-proportions rank tests determined if differences in perceived MFBs existed between students based on plan to pursue PGT. Results. Among 1218 (69.5%) respondents, 37.1% planned to pursue PGT (32.9% did not, 30% were undecided). Students introduced to PGT prior to beginning pharmacy school more frequently planned to pursue PGT. More students who planned to pursue PGT had hospital work experience. The primary PGT rationale was, "I desire to gain more knowledge and experience." Student debt was the most commonly cited barrier. Conclusion. Introducing pharmacy students early to PGT options and establishing work experiences in the hospital setting may increase students' desire to pursue PGT.
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Affiliation(s)
- Drayton A. Hammond
- University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, Arkansas
| | | | | | - Jacob T. Painter
- University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, Arkansas
| | - Scott Bolesta
- Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, Pennsylvania
| | | | - Brett J. Bailey
- University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, Arkansas
| | - Trisha Branan
- University of Georgia College of Pharmacy, Athens, Georgia
| | | | - Brianne Dunn
- South Carolina College of Pharmacy – USC Campus, Columbia, South Carolina
| | - Jason S. Haney
- South Carolina College of Pharmacy – Charleston, South Carolina
| | - Paul Juang
- St. Louis College of Pharmacy, St. Louis, Missouri
| | | | - Tyree H. Kiser
- University of Colorado School of Pharmacy, Aurora, Colorado
| | - Hira Shafeeq
- St. John’s University College of Pharmacy and Health Sciences, New York, New York
| | - Debra Skaar
- University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | | | - Jodi Taylor
- Union University School of Pharmacy, Jackson, Tennessee
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Oyler DR, Romanelli F, Piascik P, Cain J. Practical Insights for the Pharmacist Educator on Student Engagement. Am J Pharm Educ 2016; 80:143. [PMID: 27899839 PMCID: PMC5116795 DOI: 10.5688/ajpe808143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 09/17/2015] [Indexed: 05/30/2023]
Abstract
Student engagement continues to be a point of emphasis in pharmacy education, yet there remains little data on tangible means to increase organic student engagement. This review attempts to better define student engagement, draws from educational theorists to emphasize the importance of student engagement, and provides the reader with practice philosophies that can be used across of variety of teaching settings to help develop an engaging learning environment.
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Affiliation(s)
- Douglas R. Oyler
- University of Kentucky HealthCare, Department of Pharmacy, Lexington, Kentucky
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Frank Romanelli
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Peggy Piascik
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Jeff Cain
- University of Kentucky College of Pharmacy, Lexington, Kentucky
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Smetana KS, Cook AM, Bastin MLT, Oyler DR. Antiepileptic dosing for critically ill adult patients receiving renal replacement therapy. J Crit Care 2016; 36:116-124. [PMID: 27546759 DOI: 10.1016/j.jcrc.2016.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/06/2016] [Accepted: 06/28/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this review was to evaluate current literature for dosing recommendations for the use of antiepileptic medications in patients receiving renal replacement therapy (RRT). DATA SOURCES With the assistance of an experienced medical librarian specialized in pharmacy and toxicology, we searched MEDLINE, EMBASE, CINAHL, Web of Science, WorldCat, and Scopus through May 2016. STUDY SELECTION AND DATA EXTRACTION Four hundred three articles were screened for inclusion, of which 130 were identified as potentially relevant. Micromedex® DRUGDEX as well as package inserts were used to obtain known pharmacokinetic properties and dosage adjustment recommendations in RRT if known. DATA SYNTHESIS Data regarding antiepileptic drug use in RRT are limited and mostly consist of case reports limiting our proposed dosing recommendations. Known pharmacokinetic parameters should guide dosing, and recommendations are provided where possible. CONCLUSION Additional studies are necessary before specific dosing recommendations can be made for most antiepileptic drugs in critically ill patients receiving RRT, specifically with newer agents.
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Affiliation(s)
- Keaton S Smetana
- University of Kentucky HealthCare, Department of Pharmacy, Lexington, KY.
| | - Aaron M Cook
- University of Kentucky HealthCare, Department of Pharmacy, Lexington, KY; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science (UK College of Pharmacy), University of Kentucky, Lexington, KY.
| | - Melissa L Thompson Bastin
- University of Kentucky HealthCare, Department of Pharmacy, Lexington, KY; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science (UK College of Pharmacy), University of Kentucky, Lexington, KY.
| | - Douglas R Oyler
- University of Kentucky HealthCare, Department of Pharmacy, Lexington, KY; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science (UK College of Pharmacy), University of Kentucky, Lexington, KY.
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Affiliation(s)
- Casey C. May
- Department of Pharmacy; University of Kentucky HealthCare; Lexington Kentucky
| | - Douglas R. Oyler
- Department of Pharmacy; University of Kentucky HealthCare; Lexington Kentucky
- Department of Pharmacy Practice; University of Kentucky College of Pharmacy; Lexington Kentucky
| | - Sara E. Parli
- Department of Pharmacy; University of Kentucky HealthCare; Lexington Kentucky
- Department of Pharmacy Practice; University of Kentucky College of Pharmacy; Lexington Kentucky
| | - Cynthia L. Talley
- Division of General Surgery; Section of Acute Care Surgery; Chandler Medical Center; University of Kentucky HealthCare; Lexington Kentucky
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Oyler DR, Romanelli F. The fact of ignorance: revisiting the Socratic method as a tool for teaching critical thinking. Am J Pharm Educ 2014; 78:144. [PMID: 25258449 PMCID: PMC4174386 DOI: 10.5688/ajpe787144] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/25/2014] [Indexed: 05/24/2023]
Abstract
Critical thinking, while highly valued as an ability of health care providers, remains a skill that many educators find difficult to teach. This review provides an analysis examining why current methods of teaching critical thinking to health care students (primarily medical and pharmacy students) often fail and describes a premise and potential utility of the Socratic method as a tool to teach critical thinking in health care education.
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Affiliation(s)
- Douglas R. Oyler
- Pharmacy Services, UKHealthCare, Lexington, Kentucky
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Frank Romanelli
- University of Kentucky College of Pharmacy, Lexington, Kentucky
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Oyler DR, Smith KM, Elson EC, Bush H, Cook AM. Incorporating multiple mini-interviews in the postgraduate year 1 pharmacy residency program selection process. Am J Health Syst Pharm 2014; 71:297-304. [PMID: 24481154 DOI: 10.2146/ajhp130315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The incorporation of the multiple mini-interview (MMI) into the postgraduate year 1 (PGY1) pharmacy residency program selection process was evaluated. METHODS Four MMI stations evaluating the highest-rated nonacademic attributes of prospective residents (critical thinking, teamwork, ethical reasoning and integrity, and communication and interpersonal skills) were incorporated into the traditional PGY1 residency interview process at an academic medical center. After completion of the interview, candidates and interviewers were surveyed regarding their perceptions of the refined interview process. Data regarding scores on various components of the applicant profile were also compared for significant correlations. Descriptive statistics were calculated for questionnaire responses and individual components of candidate profiles. Pearson's correlation coefficients were calculated between MMI score, traditional interview score, age, grade point average, application score, college of pharmacy rank, and final candidate rank (subjective score). RESULTS A total of 38 candidates were interviewed, 37 of whom completed the postinterview survey. Candidates agreed that the MMI allowed them to convey their abilities effectively; however, they disagreed that it was more effective than traditional interviews. Candidates did not agree that the MMI caused less anxiety than traditional interviews. All 15 interviewers completed the postinterview survey and believed that the MMI effectively evaluated soft skills and that the MMI was more effective than traditional interviews in assessing candidates' abilities, skills, and thought processes. CONCLUSION The use of the MMI in a PGY1 pharmacy residency applicant selection process appeared to be well accepted by both candidates and interviewers and likely assesses different attributes than do traditional interview techniques.
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Affiliation(s)
- Douglas R Oyler
- Douglas R. Oyler, Pharm.D., is Postgraduate Year 1 Pharmacy Resident, Department of Pharmacy, UK HealthCare, Lexington, KY. Kelly M. Smith, Pharm.D., BCPS, FASHP, FCCP, is Associate Dean of Academic and Student Affairs, University of Kentucky College of Pharmacy, Lexington. E. Claire Elson, Pharm.D., is Postgraduate Year 2 Pediatrics Resident, Department of Pharmacy, St. Louis Children's Hospital, St. Louis, MO. Heather Bush, Ph.D., is Assistant Professor, Department of Biostatistics, University of Kentucky College of Public Health, Lexington. Aaron M. Cook, Pharm.D., BCPS, is Clinical Coordinator, Neurosciences/Pulmonary-Critical Care, Department of Pharmacy, UK HealthCare, and Assistant Adjunct Professor, University of Kentucky College of Pharmacy
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33
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Affiliation(s)
- Douglas R. Oyler
- University of Kentucky UK HealthCare 800 Rose Street, H112 Lexington, KY 40508
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