Skip to main content

Main menu

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • Other Publications
    • abfm

User menu

Search

  • Advanced search
American Board of Family Medicine
  • Other Publications
    • abfm
American Board of Family Medicine

American Board of Family Medicine

Advanced Search

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • JABFM on Bluesky
  • JABFM On Facebook
  • JABFM On Twitter
  • JABFM On YouTube
Research ArticleResearch Letter

Academic Detailing for Postpartum Opioid Prescribing

Katya Alcaraz Voelker and Charles Schauberger
The Journal of the American Board of Family Medicine November 2018, 31 (6) 944-946; DOI: https://doi.org/10.3122/jabfm.2018.06.180071
Katya Alcaraz Voelker
From Department of Medical Education (KAV), and Department of Obstetrics and Gynecology (CS), Gundersen Health System, La Crosse, WI.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Charles Schauberger
From Department of Medical Education (KAV), and Department of Obstetrics and Gynecology (CS), Gundersen Health System, La Crosse, WI.
MD, MS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

Abstract

Introduction: Overprescribing opioid pain medications has become a major concern in our society due to the increasing rates of substance use disorders and the rate of accidental overdoses. The widespread availability of opioid medications suggests that patients are being prescribed opioids in amounts larger than they require for pain control. Efforts are now being made on a variety of fronts to decrease overprescribing.

Material and Methods: A quality-improvement model was applied to address this concern at one medical center in women being discharged from the hospital following childbirth. The rates and amounts at which opioids were prescribed to this population before and after an academic detailing intervention were compared.

Results: The overall percentage of women who received prescriptions for opioid medications decreased from 100% to 93% in cesarean sections (P = .054) and 15% to 9% in vaginal deliveries (P = .03). The average prescription size decreased by 5 tablets (P < .0001).

Implications: Simple quality-improvement methods may have a positive impact on opioid prescribing patterns, including decreasing the percentage of opioids postdelivery or the quantity of opioids per prescription.

  • Childbirth
  • Drug Overdose
  • Inappropriate Prescribing
  • Opioid Analgesics
  • Pain Management
  • Quality Improvement

Excessive prescribing of opioid pain medications has been linked to an increased risk of overdose deaths and higher rates of opioid use disorder. Investigators have studied opioid prescription rates and amounts of medications used by patients after various procedures and operations, including childbirth. Jarlenski et al1 found that 12% of patients filled an opioid prescription after a vaginal delivery. Osmundson and colleagues2 reported that 83% of patients were prescribed opioids after cesarean section and used them for a median of 8 days.

Our review of the literature revealed a paucity of quality-improvement studies that correspond to the prescribing of opioids and none that related to postpartum prescribing. In 2016, Burton et al3 described a quality-improvement initiative to decrease emergency physician opioid prescribing involving a process of measuring, reporting, and remeasuring that demonstrated significant decreases in the number and size of prescriptions. Our report describes a similar effort to “right-size” prescribing in obstetric patients through a quality-improvement format of providing baseline data, academic detailing, and remeasurement.

Materials and Methods

This study was conducted at the Gundersen Medical Center, with a total of 19 delivering providers, including obstetricians, nurse-midwives, and family medicine physicians. Using billing records, we identified all women who delivered from January 1, 2016, through March 31, 2016. Mothers experiencing a stillbirth were excluded. Electronic medical records were used to collect demographic and clinical data, including opioid prescriptions at discharge. Validation was performed in a small number of medical records.

We used a nonpunitive method to send a quality report with pooled baseline data to all delivering providers. Providers could compare themselves with the total group rates individually. “Academic detailing” was performed with providers using a literature review. All questions were answered and the message reinforced. Data collection was repeated for deliveries from January 1, 2017, through March 31, 2017.

Results

The 2016 baseline group (n = 297) and 2017 remeasurement group (n = 323) were similar in age, parity, tobacco use, and Edinburgh Postnatal Depression Scale scores (see Table 1). The only statistically significant difference noted was a higher rate of induced labor in 2017. However, postpartum opioid prescribing neither increased nor decreased in patients whose labors were induced (P = .67). The number of tablets prescribed per prescription decreased by a median of 5 tablets, and the morphine milligram equivalents prescribed decreased from 171 to 143 (P = .001).

View this table:
  • View inline
  • View popup
Table 1.

Demographic and Clinical Characteristics of Obstetric Patients

The preferred postpartum medication was hydrocodone/acetaminophen. Oxycodone-containing prescriptions were provided to 8 patients in 2016 versus 5 patients in the 2017 period; therefore, Figure 1 presents data for hydrocodone prescriptions only.

Figure 1.
  • Download figure
  • Open in new tab
Figure 1.

Average number of hydrocodone/acetaminophen tablets prescribed before and after academic detailing intervention—cesarean (C/S) and vaginal deliveries.

The percentage of prescriptions for opioids after a cesarean section decreased from 100% to 93%, a downward trend, but it was not statistically significant (P = .054). However, the number of tablets prescribed decreased significantly (P = .0002). The percentage of prescriptions following vaginal delivery decreased significantly from 15% to 9% (P = .03) without a significant change in number of tablets prescribed (P = .26; Figure 1).

Conclusion

Our study showed a decreased number and size of opioid prescriptions following intervention. The improvements noted in our study were probably not entirely secondary to our intervention, given that this time period was associated with a 12% decrease in prescribing in Wisconsin after initiation of its Prescription Drug Monitoring Program4; however, it does show a model that is reproducible for prescribing postpartum and for other procedures and patient groups. The availability of opioids in the community must be reduced to combat misuse and its many consequences. The ability to use the electronic medical record for this sort of study has been underused in our opinion and should be explored in much greater depth and breadth.

Notes

  • This article was externally peer reviewed.

  • Funding: none.

  • Conflict of interest: none declared.

  • To see this article online, please go to: http://jabfm.org/content/31/6/944.full.

  • Received for publication March 1, 2018.
  • Revision received July 12, 2018.
  • Accepted for publication July 12, 2018.

References

  1. 1.↵
    1. Jarlenski M,
    2. Bodnar LM,
    3. Kim JY,
    4. Donohue J,
    5. Krans EE,
    6. Bogen DL
    . Filled prescriptions for opioids after vaginal delivery. Obstet Gynecol 2017;129:431–7.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Osmundson SS,
    2. Schornack LA,
    3. Grasch JL,
    4. Zuckerwise LC,
    5. Young JL,
    6. Richardson MG
    . Postdischarge opioid use after cesarean delivery. Obstet Gynecol 2017;130:36–41.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Burton JH,
    2. Hoppe JA,
    3. Echternach JM,
    4. Rodgers JM,
    5. Donato M
    . Quality improvement initiative to decrease variability of emergency physician opioid analgesic prescribing. West J Emerg Med 2016;17:258–63.
    OpenUrlPubMed
  4. 4.↵
    1. Nygren J
    . Opioid prescriptions fall drastically [news release]. Available from: http://www.thewheelerreport.com/wheeler_docs/files/1106nygrenrev.pdf. Published 2017. Accessed November 28, 2017.
PreviousNext
Back to top

In this issue

The Journal of the American Board of Family  Medicine: 31 (6)
The Journal of the American Board of Family Medicine
Vol. 31, Issue 6
November-December 2018
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Academic Detailing for Postpartum Opioid Prescribing
(Your Name) has sent you a message from American Board of Family Medicine
(Your Name) thought you would like to see the American Board of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
1 + 15 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Academic Detailing for Postpartum Opioid Prescribing
Katya Alcaraz Voelker, Charles Schauberger
The Journal of the American Board of Family Medicine Nov 2018, 31 (6) 944-946; DOI: 10.3122/jabfm.2018.06.180071

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Academic Detailing for Postpartum Opioid Prescribing
Katya Alcaraz Voelker, Charles Schauberger
The Journal of the American Board of Family Medicine Nov 2018, 31 (6) 944-946; DOI: 10.3122/jabfm.2018.06.180071
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Materials and Methods
    • Results
    • Conclusion
    • Notes
    • References
  • Figures & Data
  • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Practice-based Research Network (PBRN) Engagement: 20+ Years and Counting
  • Google Scholar

More in this TOC Section

  • Timing of Certification Stage Completion Associated with Subsequent Certification Exam Outcomes Among Board-Certified Family Physicians
  • Interpersonal Continuity of Care May Help Delay Progression to Type 2 Diabetes
  • Impact of Point of Care Hemoglobin A1c Testing on Time to Therapeutic Intervention
Show more Research Letter

Similar Articles

Keywords

  • Childbirth
  • Drug Overdose
  • Inappropriate Prescribing
  • Opioid Analgesics
  • Pain Management
  • Quality Improvement

Navigate

  • Home
  • Current Issue
  • Past Issues

Authors & Reviewers

  • Info For Authors
  • Info For Reviewers
  • Submit A Manuscript/Review

Other Services

  • Get Email Alerts
  • Classifieds
  • Reprints and Permissions

Other Resources

  • Forms
  • Contact Us
  • ABFM News

© 2025 American Board of Family Medicine

Powered by HighWire