Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives

Abstract Background Recent increases in state laws to reduce opioid prescribing have demonstrated a need to understand how they are interpreted and implemented in healthcare systems. The purpose of this study was to explore the systems, strategies, and resources that hospital administrators and pres...

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Autores principales:	Natalie A. Blackburn, Elizabeth Joniak-Grant, Maryalice Nocera, Samantha Wooten Dorris, Nabarun Dasgupta, Paul R. Chelminski, Timothy S. Carey, Li-Tzy Wu, David A. Edwards, Stephen W. Marshall, Shabbar I. Ranapurwala
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/a1b34d1c3c2c4276bbdc0b735b3521b3
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spelling	oai:doaj.org-article:a1b34d1c3c2c4276bbdc0b735b3521b32021-11-07T12:10:59ZImplementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives10.1186/s12913-021-07230-51472-6963https://doaj.org/article/a1b34d1c3c2c4276bbdc0b735b3521b32021-11-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07230-5https://doaj.org/toc/1472-6963Abstract Background Recent increases in state laws to reduce opioid prescribing have demonstrated a need to understand how they are interpreted and implemented in healthcare systems. The purpose of this study was to explore the systems, strategies, and resources that hospital administrators and prescribers used to implement the 2017 North Carolina Strengthen Opioid Prevention (STOP) Act opioid prescribing limits, which limited initial prescriptions to a five (for acute) or seven (for post-surgical) days’ supply. Methods We interviewed 14 hospital administrators and 38 prescribers with degrees in medicine, nursing, pharmacy, business administration and public health working across North Carolina. Interview guides, informed by the Consolidated Framework for Implementation Research, explored barriers and facilitators to implementation. Interview topics included communication, resources, and hospital system support. Interviews were recorded and transcribed, then analyzed using flexible coding, integrating inductive and deductive coding, to inform analytic code development and identify themes. Results We identified three main themes around implementation of STOP act mandated prescribing limits: organizational communication, prescriber education, and changes in the electronic medical record (EMR) systems. Administrators reflected on implementation in the context of raising awareness and providing reminders to facilitate changes in prescriber behavior, operationalized through email and in-person communications as well as dedicated resources to EMR changes. Prescribers noted administrative communications about prescribing limits often focused on legality, suggesting a directive of the organization’s policy rather than a passive reminder. Prescribers expressed a desire for more spaces to have their questions answered and resources for patient communications. While hospital administrators viewed compliance with the law as a priority, prescribers reflected on concerns for adequately managing their patients’ pain and limited time for clinical care. Conclusions Hospital administrators and prescribers approached implementation of the STOP act prescribing limits with different mindsets. While administrators were focused on policy compliance, prescribers were focused on their patients’ needs. Strategies to implement the mandate then had to balance patient needs with policy compliance. As states continue to legislate to prevent opioid overdose deaths, understanding how laws are implemented by healthcare systems and prescribers will improve their effectiveness through tailoring and maximizing available resources.Natalie A. BlackburnElizabeth Joniak-GrantMaryalice NoceraSamantha Wooten DorrisNabarun DasguptaPaul R. ChelminskiTimothy S. CareyLi-Tzy WuDavid A. EdwardsStephen W. MarshallShabbar I. RanapurwalaBMCarticlePublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Public aspects of medicine RA1-1270
spellingShingle	Public aspects of medicine RA1-1270 Natalie A. Blackburn Elizabeth Joniak-Grant Maryalice Nocera Samantha Wooten Dorris Nabarun Dasgupta Paul R. Chelminski Timothy S. Carey Li-Tzy Wu David A. Edwards Stephen W. Marshall Shabbar I. Ranapurwala Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives
description	Abstract Background Recent increases in state laws to reduce opioid prescribing have demonstrated a need to understand how they are interpreted and implemented in healthcare systems. The purpose of this study was to explore the systems, strategies, and resources that hospital administrators and prescribers used to implement the 2017 North Carolina Strengthen Opioid Prevention (STOP) Act opioid prescribing limits, which limited initial prescriptions to a five (for acute) or seven (for post-surgical) days’ supply. Methods We interviewed 14 hospital administrators and 38 prescribers with degrees in medicine, nursing, pharmacy, business administration and public health working across North Carolina. Interview guides, informed by the Consolidated Framework for Implementation Research, explored barriers and facilitators to implementation. Interview topics included communication, resources, and hospital system support. Interviews were recorded and transcribed, then analyzed using flexible coding, integrating inductive and deductive coding, to inform analytic code development and identify themes. Results We identified three main themes around implementation of STOP act mandated prescribing limits: organizational communication, prescriber education, and changes in the electronic medical record (EMR) systems. Administrators reflected on implementation in the context of raising awareness and providing reminders to facilitate changes in prescriber behavior, operationalized through email and in-person communications as well as dedicated resources to EMR changes. Prescribers noted administrative communications about prescribing limits often focused on legality, suggesting a directive of the organization’s policy rather than a passive reminder. Prescribers expressed a desire for more spaces to have their questions answered and resources for patient communications. While hospital administrators viewed compliance with the law as a priority, prescribers reflected on concerns for adequately managing their patients’ pain and limited time for clinical care. Conclusions Hospital administrators and prescribers approached implementation of the STOP act prescribing limits with different mindsets. While administrators were focused on policy compliance, prescribers were focused on their patients’ needs. Strategies to implement the mandate then had to balance patient needs with policy compliance. As states continue to legislate to prevent opioid overdose deaths, understanding how laws are implemented by healthcare systems and prescribers will improve their effectiveness through tailoring and maximizing available resources.
format	article
author	Natalie A. Blackburn Elizabeth Joniak-Grant Maryalice Nocera Samantha Wooten Dorris Nabarun Dasgupta Paul R. Chelminski Timothy S. Carey Li-Tzy Wu David A. Edwards Stephen W. Marshall Shabbar I. Ranapurwala
author_facet	Natalie A. Blackburn Elizabeth Joniak-Grant Maryalice Nocera Samantha Wooten Dorris Nabarun Dasgupta Paul R. Chelminski Timothy S. Carey Li-Tzy Wu David A. Edwards Stephen W. Marshall Shabbar I. Ranapurwala
author_sort	Natalie A. Blackburn
title	Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives
title_short	Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives
title_full	Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives
title_fullStr	Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives
title_full_unstemmed	Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives
title_sort	implementation of mandatory opioid prescribing limits in north carolina: healthcare administrator and prescriber perspectives
publisher	BMC
publishDate	2021
url	https://doaj.org/article/a1b34d1c3c2c4276bbdc0b735b3521b3
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Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives

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