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Opioid Prescription and Usage after Provider Education and SMS-based Parent Education
Andrea H. Rossman, BSE, Keerthana Mohankumar, MD, Raymond Yong, MD, Angela Thao, MPH, Katie Sheridan, BS, Elizabeth Roth, MD.
Medical College of Wisconsin, Milwaukee, WI, USA.

Background: Overprescribing opioid pain medication after surgery is an increasing public health concern due to the potential for medication diversion and risk of opioid abuse and dependence in the population. Efforts have been made to educate providers to decrease doses prescribed in order to decrease unused medication, but there have been few reports of whether patient education can improve responsible opioid disposal to decrease excess post-surgical opioids. In this study, we present a two-component quality improvement intervention to decrease opioid prescriptions and increase opioid disposal. The intervention included non-binding provider education and a novel SMS-text platform to deliver parent education about post-operative pain management and narcotic disposal. We hypothesized that provider and parent education about opioid use and disposal would decrease the number of opioids prescribed and improve opioid disposal rates in an outpatient pediatric urologic surgery setting.
Methods: This study was a quality initiative study including 144 patients at a single academic institution. Baseline data was collected from a prospective analysis of provider opioid prescribing patterns and usage for outpatient pediatric urologic surgery performed July 27 - September 4, 2020. Data was collected on demographics, surgery type, local anesthetic use, and post-operative opioid prescriptions. Parent phone surveys were conducted 1-4 weeks after surgery to assess pain control and medication use, storage, and disposal. Based on baseline data, a two-component intervention aimed at decreasing opioid prescriptions and increasing opioid disposal was created. The first component was provider education including recommendations for opioid prescriptions based on parent-reported post-operative use. The second component included opioid disposal education via WellHealth, a previously established SMS-text platform for scheduling appointments. SMS messages were automated by CPT code and sent during the postoperative period. Messages included instructions regarding appropriate opioid use and disposal, expected post-operative course, and activity modifications following surgery. Parent phone and SMS-linked surveys were conducted prospectively 1-4 weeks after surgery and compared to baseline responses.
Results:There were no significant demographic or surgical differences between the two groups as determined by a p value greater than 0.05 (Table 1).

Table 1: Patient Characteristics
CharacteristicBaseline Group%Intervention Group%
Number of Patients71^73*
Median Age, Years (IQR)1 (1-7)2 (1-8)
Sex
Male71100%7299%
Female00%11%
Race
White or Caucasian4969%5474%
Black or African American1217%1216%
Asian68%34%
Other34%34%
Unknown11%11%
Ethnicity
Not Hispanic/Latino6186%6082%
Hispanic/Latino811%1115%
Refused11%11%
Unknown11%11%
Surgery Type
Chordee Repair11%34%
Circumcision2028%1622%
Circumcision Revision23%45%
Distal Hypospadias Repair811%00%
Inguinal Orchiopexy2941%2737%
Scrotal Orchiopexy913%45%
Other23%1926%
Regional Block Used4969%4764%
^Two patients were excluded from analysis due to parent preference *One patient excluded for lack of available data

Significantly fewer patients were prescribed opioids after the intervention (Table 2, p=0.015 Fisher Test). This corresponded to fewer opioids prescribed per patient, as measured in morphine milligram equivalents (MMEs), p=0.023 Wilcoxon Rank Sum. The opioid disposal was significantly increased in the intervention group compared to the baseline group (p=0.023 Fishers Test). There was no difference in the parent-reported pain perception or expectation between the groups (p=0.199, p=0.199 Chi Squared).
Table 2: Opioid Prescription Rates, Pain Outcomes, Opioid Disposal
Baseline Group%Intervention Group%
Opioid Prescribed (Patient number)*3346%1926%
Mean Opioid Prescribed Per Patient (MMEs)*21.410.4
Pain Perception
Poor35%00%
Adequate1524%28%
Good4571%2492%
Pain Expectation
Worse23%00%
The Same2743%727%
Better3454%1973%
Opioid Disposal (Yes)*417%563%
*p value < 0.05

Conclusions:Provider and SMS-based parent education were associated with significantly decreased opioid prescribing without a significant change in parent-reported pain perception or expectation. We used a novel, CPT-generated, automated text message education system, which was associated with fewer opioid prescriptions and increased opioid disposal.


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