Becker's Hospital Review

92 CMO / CARE DELIVERY How Geisinger cut opioid prescriptions in half: 3 things to know By Brian Zimmerman D anville, Pa.-based Geisinger reduced opioid prescriptions by more than 50 percent systemwide since 2012, according to a report from WHYY. Here are three things to know. 1. In 2012, Geisinger leaders learned many patients were not satis- fied with the health system's pain control efforts. After assessing EHR data, the leaders found Geisinger physicians often prescribed more opioids than necessary. Previous research has shown relying on too many opioids for pain management can cause a heightened sensitiv- ity to pain, according to the report. 2. Michael Evans, Geisinger's chief pharmacy officer, told WHYY the health system's leaders showed the EHR data to physicians who were overprescribing opioids. "And, most of the time, the reaction from the prescribers [was], 'Wow, I had no idea I was prescribing like that," Mr. Evans told WHYY. 3. To solve the issue, Geisinger pharmacists and physicians worked together to develop new strategies to treat pain without opioids when appropriate. For example, providers placed a higher empha- sis on the importance of physical therapy for lower back pain pa- tients, which proved a more effective treatment than medication. Overall, these efforts resulted in the 50 percent reduction in opioid prescriptions. n JAMA: More practices rely on NPs, PAs By Kelly Gooch T he number of physician specialty practices employing nurse practitioners and physician assistants rose 22 percent from 2008 to 2016, according to a study published April 30 in JAMA Internal Medicine. For the study, researchers examined SK&A outpatient provider files to assess the employment trends of NPs and PAs in physician special- ty practices. The study found approximately 28 percent of physician specialty practices employed NPs and PAs in 2016, compared to 23 percent in 2008. Nearly half of multispecialty practices (49 percent) employed such workers in 2016, while 21 percent of surgical specialties did the same. Among specialty practices, dermatology, cardiology and ob- stetrics/gynecology employed the most number of NPs and PAs. From 2008 to 2016, the number of physician specialty practices em- ploying NPs and PAs increased 22 percent. Additionally, primary care physician practices employing NPs and PA rose 24 percent over the same time period. "Because the NP role was historically developed to focus on prima- ry care and most advanced practice clinicians are NPs, one would expect that advanced practice clinicians would have a greater pres- ence in primary care practices," the study's authors note, according to the American Hospital Association. n Scientists are developing a vaccine to end addiction: 5 things to know By Megan Knowles I n the midst of the nation's opioid crisis, scientists are developing an experimental vaccine that aims to treat addicted patients who would be at risk of death if they detoxified and then relapsed, according to e New York Times. Here are five things to know. 1. If the vaccine is successful, it would stop opioids by keeping them from reaching the brain through the circulatory system. At the same time, the vaccine would not interfere with other treatments for ad- dicts, like methadone and buprenorphine, or with a compound such as naloxone, which reverses opioid overdoses. 2. e vaccine works to create high levels of antibod- ies, said Gary Matyas, PhD, an immunologist who is developing the vaccine at Silver Springs, Md.-based Walter Reed Army Institute of Research. "You inject heroin, the antibodies basically grab all the heroin, bind it all up, and the heroin can't cross the blood- brain barrier," he told e New York Times. As a re- sult, the patient does not feel a high, Dr. Matyas said. In time, the heroin would be expelled from the body like any waste product. 3. For addicts, the vaccine would serve as part of their therapy for recovering, Dr. Matyas said. "If they mess up and take a dose of heroin, the heroin won't work." However, the vaccine is not yet certain to work and must still be tested on humans. It could take more than 10 years for there to be a licensed product, Dr. Matyas said. 4. Researchers still need to determine how large the dosages would have to be and how oen they would need to be administered. However, the vaccine's suc- cess with lab mice and rats continues to encourage Dr. Matyas. 5. Although the process of testing and receiving ap- proval from federal authorities for the experimental vaccine will take years to complete, Dr. Matyas ex- pressed faith in the potential to help turn the opioid crisis around. In particular, the medication would greatly reduce the risk of overdoses by preventing users from getting high. at is the vaccine's "true vision," Dr. Matyas said. n

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