A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits.
BACKGROUND
Increasing prescription overdose deaths have demonstrated the need for safer emergency department (ED) prescribing practices for patients who are frequent ED users.


OBJECTIVE
We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients.


METHODS
We conducted a multisite randomized controlled trial (RCT) across all EDs in a metropolitan area; 165 patients with the most ED visits for complaints of pain were randomized. For the treatment arm, drivers of ED use were identified by medical record review. Patients and their primary care providers were contacted by phone. Each patient was discussed at a community multidisciplinary meeting where recommendations for ED care were formed. The ED care recommendations were stored in an ED information exchange system that faxed them to the treating ED provider when the patient presented to the ED. The control arm was subjected to treatment as usual.


RESULTS
The intervention arm experienced a 34% decrease (incident rate ratios = 0.66, p < 0.001; 95% confidence interval 0.57-0.78) in ED visits and an 80% decrease (odds ratio = 0.21, p = 0.001) in the odds of receiving an opioid prescription from the ED relative to the control group. Declines of 43.7%, 53.1%, 52.9%, and 53.1% were observed in the treatment group for morphine milligram equivalents, controlled substance pills, prescriptions, and prescribers, respectively.


CONCLUSIONS
This RCT showed the effectiveness of a citywide ED care coordination program in reducing ED visits and controlled substance prescribing.
Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington; Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.
Darin
D
Neven
National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
Leonard
L
Paulozzi
Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington.
Donelle
D
Howell
Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.
Sterling
S
McPherson
Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington; Department of Health Policy and Administration, Washington State University College of Nursing, Spokane, Washington.
Sean M
SM
Murphy
Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington.
Becky
B
Grohs
Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington.
Linda
L
Marsh
Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington.
Crystal
C
Lederhos
Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington.
John
J
Roll
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care / Q000706:statistics & numerical data / Q000639:trends; D003299:Cooperative Behavior; D062787:Drug Overdose / Q000517:prevention & control*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy; D063487:Prescription Drug Misuse / Q000009:adverse effects / Q000706:statistics & numerical data*; D014861:Washington
D000701:Analgesics, Opioid
ED care coordination; frequent ED users; opioid prescribing; prescription drug monitoring program; prescription opioid abuse