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Research

Effect of a centralized prescription network on inappropriate prescriptions for opioid analgesics and benzodiazepines

Colin R. Dormuth, Tarita A. Miller, Anjie Huang, Muhammad M. Mamdani and David N. Juurlink
CMAJ November 06, 2012 184 (16) E852-E856; DOI: https://doi.org/10.1503/cmaj.120465
Colin R. Dormuth
From the Department of Anesthesiology, Pharmacology and Therapeutics (Dormuth), University of British Columbia, Vancouver, BC; the Therapeutics Initiative (Dormuth, Miller), University of British Columbia, Vancouver, BC; the Institute for Clinical Evaluative Sciences (Huang, Mamdani, Juurlink), Toronto, Ont.; the Institute of Health Policy, Management and Evaluation (Mamdani), University of Toronto, Toronto, Ont.; the Li Ka Shing Knowledge Institute of St. Michael’s Hospital (Mamdani), Toronto, Ont.; the Sunnybrook Research Institute (Juurlink), Sunnybrook Health Sciences Centre, Toronto, Ont.; and the Departments of Medicine and Pediatrics (Juurlink), University of Toronto, Toronto, Ont.
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  • For correspondence: colin.dormuth@ti.ubc.ca
Tarita A. Miller
From the Department of Anesthesiology, Pharmacology and Therapeutics (Dormuth), University of British Columbia, Vancouver, BC; the Therapeutics Initiative (Dormuth, Miller), University of British Columbia, Vancouver, BC; the Institute for Clinical Evaluative Sciences (Huang, Mamdani, Juurlink), Toronto, Ont.; the Institute of Health Policy, Management and Evaluation (Mamdani), University of Toronto, Toronto, Ont.; the Li Ka Shing Knowledge Institute of St. Michael’s Hospital (Mamdani), Toronto, Ont.; the Sunnybrook Research Institute (Juurlink), Sunnybrook Health Sciences Centre, Toronto, Ont.; and the Departments of Medicine and Pediatrics (Juurlink), University of Toronto, Toronto, Ont.
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Anjie Huang
From the Department of Anesthesiology, Pharmacology and Therapeutics (Dormuth), University of British Columbia, Vancouver, BC; the Therapeutics Initiative (Dormuth, Miller), University of British Columbia, Vancouver, BC; the Institute for Clinical Evaluative Sciences (Huang, Mamdani, Juurlink), Toronto, Ont.; the Institute of Health Policy, Management and Evaluation (Mamdani), University of Toronto, Toronto, Ont.; the Li Ka Shing Knowledge Institute of St. Michael’s Hospital (Mamdani), Toronto, Ont.; the Sunnybrook Research Institute (Juurlink), Sunnybrook Health Sciences Centre, Toronto, Ont.; and the Departments of Medicine and Pediatrics (Juurlink), University of Toronto, Toronto, Ont.
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Muhammad M. Mamdani
From the Department of Anesthesiology, Pharmacology and Therapeutics (Dormuth), University of British Columbia, Vancouver, BC; the Therapeutics Initiative (Dormuth, Miller), University of British Columbia, Vancouver, BC; the Institute for Clinical Evaluative Sciences (Huang, Mamdani, Juurlink), Toronto, Ont.; the Institute of Health Policy, Management and Evaluation (Mamdani), University of Toronto, Toronto, Ont.; the Li Ka Shing Knowledge Institute of St. Michael’s Hospital (Mamdani), Toronto, Ont.; the Sunnybrook Research Institute (Juurlink), Sunnybrook Health Sciences Centre, Toronto, Ont.; and the Departments of Medicine and Pediatrics (Juurlink), University of Toronto, Toronto, Ont.
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David N. Juurlink
From the Department of Anesthesiology, Pharmacology and Therapeutics (Dormuth), University of British Columbia, Vancouver, BC; the Therapeutics Initiative (Dormuth, Miller), University of British Columbia, Vancouver, BC; the Institute for Clinical Evaluative Sciences (Huang, Mamdani, Juurlink), Toronto, Ont.; the Institute of Health Policy, Management and Evaluation (Mamdani), University of Toronto, Toronto, Ont.; the Li Ka Shing Knowledge Institute of St. Michael’s Hospital (Mamdani), Toronto, Ont.; the Sunnybrook Research Institute (Juurlink), Sunnybrook Health Sciences Centre, Toronto, Ont.; and the Departments of Medicine and Pediatrics (Juurlink), University of Toronto, Toronto, Ont.
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Abstract

Background: Opioid analgesics and benzodiazepines are often misused in clinical practice. We determined whether implementation of a centralized prescription network offering real-time access to patient-level data on filled prescriptions (PharmaNet) reduced the number of potentially inappropriate prescriptions for opioids and benzodiazepines.

Methods: We conducted a time series analysis using prescription records between Jan. 1, 1993, and Dec. 31, 1997, for residents of the province of British Columbia who were receiving social assistance or were 65 years or older. We calculated monthly percentages of filled prescriptions for an opioid or a benzodiazepine that were deemed inappropriate (those issued by a different physician and dispensed at a different pharmacy within 7 days after a filled prescription of at least 30 tablets of the same drug).

Results: Within 6 months after implementation of PharmaNet in July 1995, we observed a relative reduction in inappropriate filled prescriptions for opioids of 32.8% (95% confidence interval [CI] 31.0%–34.7%) among patients receiving social assistance; inappropriate filled prescriptions for benzodiazepines decreased by 48.6% (95% CI 43.2%–53.1%). Similar and statistically significant reductions were observed among residents 65 years or older.

Interpretation: The implementation of a centralized prescription network was associated with a dramatic reduction in inappropriate filled prescriptions for opioids and benzodiazepines.

See related commentary by Wilsey and Prasad at www.cmaj.ca/lookup/doi/10.1503/cmaj.121495

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Canadian Medical Association Journal: 184 (16)
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Vol. 184, Issue 16
6 Nov 2012
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Effect of a centralized prescription network on inappropriate prescriptions for opioid analgesics and benzodiazepines
Colin R. Dormuth, Tarita A. Miller, Anjie Huang, Muhammad M. Mamdani, David N. Juurlink
CMAJ Nov 2012, 184 (16) E852-E856; DOI: 10.1503/cmaj.120465

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Effect of a centralized prescription network on inappropriate prescriptions for opioid analgesics and benzodiazepines
Colin R. Dormuth, Tarita A. Miller, Anjie Huang, Muhammad M. Mamdani, David N. Juurlink
CMAJ Nov 2012, 184 (16) E852-E856; DOI: 10.1503/cmaj.120465
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