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Changes in Opioid Prescribing Habits after Implementation of Electronic Prescription Drug Monitoring Program
Viraj Maniar, MD1, Elizabeth B. Roth, MD2.
1Medical College of Wisconsin, Milwaukee, WI, USA, 2Children's Hospital of Wisconsin, Milwaukee, WI, USA.

Introduction
While acute postoperative pain is a recognized indication for opioid pain management, studies suggest that patients are often prescribed more opioid doses than required. These resulting excess opioids pose risk for both accidental ingestion and misuse in pediatric patients. Given the increasing recognition of excess opioids as a public health concern, electronic prescription drug monitoring programs have been implemented in 49 states. This is exemplified by the state of Wisconsin's mandatory electronic Prescription Drug Monitoring Program (ePDMP) which was implemented in 2017. We aimed to examine the effect of this ePDMP implementation on prescribing patterns among pediatric urologists at our institution by evaluating prescribing habits before and after implementation of this program.
Methods
We performed retrospective review of 695 pediatric patients who underwent an outpatient urologic procedure at a single institution by 6 surgeons from August 2016 to December 2017. Charts were reviewed for demographic data, type of procedure performed, and number of opioid doses prescribed. Patients were divided into two groups, those undergoing surgery before and after ePDMP implementation. Analysis was performed using standard bivariate non-parametric tests as well as multivariable logistic regression.
Results
Of the 695 cases reviewed, 304 had surgery prior to ePDMP implementation and 391 had surgery after implementation. Most common cases performed were inguinal orchiopexy (259), circumcision (237) and inguinal hernia repair (67). Case distribution, age, weight, and race were similar between the groups (Figure 1). Patients who had surgery prior to ePDMP implementation were given an opioid prescription 93.1% of the time with a mean 19.8 doses prescribed compared to 87.7% given an opioid prescription with a mean 14.1 doses prescribed after ePDMP implementation (p=0.019).
Logistic regression was used to determine patient characteristics associated with receipt of an opioid prescription after surgery. Older children were associated with a higher odd of receiving an opioid prescription (OR = 1.61, p < 0.05). Circumcision was associated with lower odds of receiving an opioid prescription (OR = 0.37, p< 0.05). Implementation of the ePDMP program did not have any statistically significant effect on receiving an opioid prescription.
Conclusion
After implementation of ePDMP, percentage of patients receiving opioid prescriptions and mean doses per opioid prescription decreased. This association was not found to hold after controlling for patient demographics, surgeon, or procedure performed. More research is needed to assess the effect of the ePDMP on the state's opioid prescribing practices.
Figure 1

pre-ePDMPpost-ePDMPp value
patients304391
age (avg. in yrs)5.445.650.55
weight (avg. in kg)23.924.90.497
race0.469
white196 (64.5%)269 (68.8%)
black49 (16.1%)62 (15.9%)
asian29 (9.53%)25 (6.39%)
american indian1 (0.33%)3 (0.77%)
unknown31 (10.2%)30 (7.67%)
doses of opioids (avg.)19.814.1<0.001
surgery
circumcision98 (32.3%)139 (35.5%)0.546
inguinal hernia repair32 (10.5%)35 (8.95%)
inguinal orchidopexy120 (39.5%)139 (35.5%)
other54 (17.8%)78 (19.9%)
opioid prescription93.10%87.70%0.019

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