title: The impact of pharmacy services on opioid prescribing in dental practice.
abstract: OBJECTIVE
  To compare rates of dental opioid prescribing between periods of full and partial integration of pharmacy services and periods of no integration.
  
  
  METHODS
  This observational study used a retrospective chart review of opioid prescriptions written by dental providers practicing in a free dental clinic for the medically underserved over a period of 74 months. Pharmacy services were fully integrated into the practice model for 48 of the 74 months under study. During this time frame, all dental opioid orders required review by the pharmacy department before prescribing. Outcomes related to prescribing rates and errors were compared between groups, which were defined by the level of integrated pharmacy services. Demographic and prescription-specific data (drug name, dose, quantity, directions, professional designation of individual entering order) and clinic appointment data were collected and analyzed with the use of descriptive and inferential statistics.
  
  
  RESULTS
  A total of 102 opioids were prescribed to 89 patients; hydrocodone-acetaminophen combination products were the most frequently used. Opioid prescribing rates were 5 times greater when pharmacy services were not integrated (P <0.001); and dentists were 81% less likely to prescribe opioids when pharmacy was fully integrated (odds ratio 0.19, 95% confidence interval 0.124-0.293; P <0.001). Frequency of hydrocodone use compared with other opioids did not decrease after the rescheduling of hydrocodone to a Schedule II controlled substance. The frequency of prescribing errors was not statistically different between groups, although there were numerically fewer errors with integrated pharmacy services.
  
  
  CONCLUSIONS
  The literature reports that dentists are the third most frequent prescribers of opioids. The findings from this study suggest that collaboration between pharmacists and dentists has the potential to decrease opioid utilization in primary dental practice.
authors.forename: Autumn
authors.initials: A
authors.lastname: Stewart
authors.forename: Kelsey J
authors.initials: KJ
authors.lastname: Zborovancik
authors.forename: Kara L
authors.initials: KL
authors.lastname: Stiely
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D003729:Dental Care / Q000458:organization & administration; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage; D008297:Male; D008507:Medically Underserved Area; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration*; D019239:Practice Patterns, Dentists' / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D004338:Drug Combinations; C083640:acetaminophen, hydrocodone drug combination; D000082:Acetaminophen; D006853:Hydrocodone