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When Evidence-Based Guidelines Aren’t Enough: The Effects of Institutional Protocols and State Legislation on Opioid Use in Total Hip Arthroplasty

When Evidence-Based Guidelines Aren’t Enough: The Effects of Institutional Protocols and State Legislation on Opioid Use in Total Hip Arthroplasty

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Developed in collaboration
Med-IQ      Duke Medicine

Online Course | Specialties: Orthopedic Surgery, Pain Management, Sports Medicine
Released: 2/14/2022
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Expires: 2/13/2023
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Max Credits: 0.25
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Faculty
Brian Lewis, MD
Hip Arthroscopist, Hip Specialist, Orthopaedic Surgeon
Assistant Professor of Orthopaedic Surgery
Duke University School of Medicine
Durham, NC
  
Activity Planners
Genevieve Olucha, PhD
Clinical Content Manager
Med-IQ
Baltimore, MD

Kerry Kennedy, ELS
Editorial Manager
Med-IQ
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Med-IQ
Baltimore, MD

Amy Sison
Director of CME
Med-IQ
Baltimore, MD

Writer
Anne Jacobson, MSPharm, CHCP
Cocoa Beach, FL
 
Learning Objectives
Upon completion, participants should be able to:

  • Discuss the prevalence and consequences of opioid overprescribing within the field of orthopaedics
  • Describe the effects of institutional guidelines and state/federal legislation on narcotic filling in total hip arthroplasty

Target Audience
This activity is intended for orthopaedic surgeons and doctors, pain management providers, and physical medicine and rehabilitation providers.
 
Statement of Need
Because many patients begin their cycle of opioid dependence with legal prescriptions for acute pain, including postoperative pain, examination of legal postoperative prescriptions is appropriate as part of a multifaceted approach to battle the ongoing opioid crisis. Orthopaedic surgeons are the third-largest group of opioid prescribers among physicians and are challenged to adequately control their patient’s pain after complex and painful surgeries, such as total joint arthroplasty. However, research has shown that, in the attempt to adequately control pain, orthopaedic surgeons may unintentionally overprescribe opioids to their patients. Institutional guidelines and legislation have been enacted to guide orthopaedic surgeons in the balance of adequate pain control, patient satisfaction, and the need to decrease high-risk opioid prescriptions. Orthopaedic surgeons and healthcare providers in adjacent fields must understand the risks of opioid overprescribing and gain knowledge on institutional, state, and national guidelines to decrease the potential for opioid misuse among patients while still providing optimal care.

Collaboration Statement
This activity was developed by Med-IQ in collaboration with Duke Health.

Accreditation/Designation Statements
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
 
Med-IQ designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
 
Medium/Method of Participation
This CME activity consists of a 0.25-credit online publication. To receive credit, read the introductory CME material, read the publication, and complete the evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.
 
Initial Release Date: February 14, 2022
Expiration Date: February 13, 2023
Estimated Time to Complete This Activity: 15 minutes

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Med-IQ requires any person in a position to control the content of an educational activity to disclose all financial relationships with any ineligible company over the past 24 months. The ACCME deems financial relationships as relevant if the educational content an individual can control is related to the business lines or products of the ineligible company. Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and mitigate COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been mitigated through an established COI mitigation process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.
 
Brian Lewis, MD
Consulting fees/advisory boards: Stryker, Zimmer Biomet

The writer, peer reviewers, and activity planners have no financial relationships to disclose.
 
Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, Med-IQ has a policy to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.

Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.

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For questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or email info@med-iq.com.

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The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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Complimentary CME
This activity is available free of charge to participants.
 
Copyright
© 2022 Duke University Health System

Abstract

Here are the key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, are available at the "Continue" button below.

  • Given the current opioid crisis in the United States, orthopaedic surgeons, who represent the third-largest group of opioid prescribers among physicians, have a duty to balance the needs of their patients’ pain management with concerns for opioid misuse
  • Many individuals begin the cycle of opioid dependence with legal prescriptions for acute pain, including postoperative pain
  • The use of high-risk prescriptions (ie, prescriptions of a high quantity, high dose, and long duration) has been shown to independently predict greater opioid use among opioid-naïve patients
  • Professional and institutional guidelines in combination with state- and federal-level legislation play separate and important roles in reducing the number of opioid prescriptions
  • Regulations that target prescription amount and duration are the most effective at reducing opioid misuse

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