Opioid Prescriptions by Specialty in Ohio, 2010-2014.

Background: The current US opioid epidemic is attributed to the large volume of prescribed opioids. This study analyzed the contribution of different medical specialties to overall opioids by evaluating the pill counts and morphine milligram equivalents (MMEs) of opioid prescriptions, stratified by provider specialty, and determined temporal trends. Methods: This was an analysis of the Ohio prescription drug monitoring program database, which captures scheduled medication prescriptions filled in the state as well as prescriber specialty. We extracted prescriptions for pill versions of opioids written in the calendar years 2010 to 2014. The main outcomes were the number of filled prescriptions, pill counts, MMEs, and extended-released opioids written by physicians in each specialty, and annual prescribing trends. Results: There were 56,873,719 prescriptions for the studied opioids dispensed, for which 41,959,581 (73.8%) had prescriber specialty type available. Mean number of pills per prescription and MMEs were highest for physical medicine/rehabilitation (PM&R; 91.2 pills, 1,532 mg, N = 1,680,579), anesthesiology/pain (89.3 pills, 1,484 mg, N = 3,261,449), hematology/oncology (88.2 pills, 1,534 mg, N = 516,596), and neurology (84.4 pills, 1,230 mg, N = 573,389). Family medicine (21.8%) and internal medicine (17.6%) wrote the most opioid prescriptions overall. Time trends in the average number of pills and MMEs per prescription also varied depending on specialty. Conclusions: The numbers of pills and MMEs per opioid prescription vary markedly by prescriber specialty, as do trends in prescribing characteristics. Pill count and MME values define each specialty's contribution to overall opioid prescribing more accurately than the number of prescriptions alone.

The Effect of Opioid Prescribing Guidelines on Prescriptions by Emergency Physicians in Ohio.

STUDY OBJECTIVE: The objective of our study is to evaluate the association between Ohio's April 2012 emergency physician guidelines aimed at reducing inappropriate opioid prescribing and the number and type of opioid prescriptions dispensed by emergency physicians. METHODS: We used Ohio's prescription drug monitoring program data from January 1, 2010, to December 31, 2014, and included the 5 most commonly prescribed opioids (hydrocodone, oxycodone, tramadol, codeine, and hydromorphone). The primary outcome was the monthly statewide prescription total of opioids written by emergency physicians in Ohio. We used an interrupted time series analysis to compare pre- and postguideline level and trend in number of opioid prescriptions dispensed by emergency physicians per month, number of prescriptions stratified by 5 commonly prescribed opioids, and number of prescriptions for greater than 3 days' supply of opioids. RESULTS: Beginning in January 2010, the number of prescriptions dispensed by all emergency physicians in Ohio decreased by 0.3% per month (95% confidence interval [CI] -0.49% to -0.15%). The implementation of the guidelines in April 2012 was associated with a 12% reduction (95% CI -17.7% to -6.3%) in the level of statewide total prescriptions per month and an additional decline of 0.9% (95% CI -1.1% to -0.7%) in trend relative to the preguideline trend. The estimated effect of the guidelines on total monthly prescriptions greater than a 3-day supply was an 11.2% reduction in level (95% CI -18.8% to -3.6%) and an additional 0.9% (95% CI -1.3% to -0.5%) decline in trend per month after the guidelines. Guidelines were also associated with a reduction in prescribing for each of the 5 individual opioids, with various effect. CONCLUSION: In Ohio, emergency physician opioid prescribing guidelines were associated with a decrease in the quantity of opioid prescriptions written by emergency physicians. Although introduction of the guidelines occurred in parallel with other opioid-related interventions, our findings suggest an additional effect of the guidelines on prescribing behavior. Similar guidelines may have the potential to reduce opioid prescribing in other geographic areas and for other specialties as well.

Examining Media Habits: implications for health promotion programs among the Toposa in Southern Sudan.

Dissemination of appropriate health education messages is essential to any health promotion campaign. This cross-sectional study examined media ownership, access and media preferences by target groups in Kapoeta South County, Southern Sudan. The target groups were segmented into household heads (n = 368); women with children under five years (n = 580); and youth 11-16 years old (n = 349). Interviewees were selected at random from 49 villages. Overall, a small portion owned radios (6.8%) and television sets (0.2%); more had access to radio (27.1%), listened to cassettes (50.8%), and had access to television and movies (21.4%). The majority were interested in programs developed in the vernacular (89.0%). A very low literacy rate (1.3%) and difficulty in understanding signage (29.7%) posed potential obstacles for use of print media as a primary source of health communication. Heads of household were more likely to own radios (P < 0.001), watch TV outside of the home (P = 0.034), and see posters (P = 0.038) than other groups. Traditional entertainment was attended by 94.4% of respondents. Information from chiefs (61.5%) and elders (51.5%) was considered trustworthy by the majority of respondents. This research highlights the utility in understanding media access, habits and preferences of community members when designing a health promotion campaign.

Evaluation of community intervention with pit latrines for trachoma control in Ghana, Mali, Niger and Nigeria.

Trachoma is the leading cause of preventable blindness worldwide and is controlled with an integrated strategy of treatment and prevention which includes latrine provision and promotion. We aimed to evaluate the latrine uptake, construction, and usage in villages participating in latrine promotion programmes supported by The Carter Center in Ghana, Mali, Niger and Nigeria where 113 457 new latrines have been reported from 2002 to 2008. In each country a two stage cluster random sampling design was used to select villages and households for evaluation. Household heads were interviewed using a standardised structured questionnaire and latrines were inspected. The sample included 1154 households (Ghana: 326; Mali: 293; Niger: 300; and Nigeria: 235). Overall, 813 (70.5%, 95% confidence interval [CI] 65.7-74.8) had pit latrines, ranging from 30.3% of households in Niger to over 92.0% of households in Ghana and Mali. Of those with latrines 762 (93.7%) were found to be usable and 659 (86.5%) were in use. Overall 659/1154 (57.1%) of households in the targeted communities were using latrines at least 12 months after latrine promotion was initiated. Latrine promotion had been successful increasing access to sanitation in different country contexts and demonstrates the target population are willing to construct, use and maintain household latrines.

Characteristics of latrine promotion participants and non-participants; inspection of latrines; and perceptions of household latrines in Northern Ghana.

OBJECTIVES: To examine characteristics of household heads in two districts of Northern Ghana who had or had not participated in latrine promotion programmes; to inspect latrines; and to explore perceptions of latrine ownership. METHODS: One hundred and twenty latrine owners and 120 non-owners were randomly selected from all trachoma-endemic villages and interviewed. Structured questionnaires assessed demographics, household data, wealth indicators, and perceptions of latrine ownership. Latrines were inspected. RESULTS: Latrine owners and non-owners were similar demographically, but owners were more likely to report any education or wealth indicators: any education OR = 2.0, (95% CI 1.2-3.4); large family size OR = 4.6 (2.6-8.2); children in school OR = 3.8 (1.3-10.5); and metal roof OR = 9.1 (2.0-40.0). All 120 latrine owners were participating in promotion programmes; no latrines had been self-built without programme support. Inspection showed 73/120 (60.1%) latrines were completed and used. Of the uncompleted latrines 41/47 (87.2%) were more than a year old. Programme participants (regardless of whether they had a completed latrine) had contributed cash (mean 16.74 dollars S.D.18.09) and 117/120 had provided labour and/or construction materials. The most frequently reported advantages of latrine ownership were convenience, cleanliness and health benefits; reported disadvantages were the need for maintenance and cleaning and bad odour. CONCLUSIONS: Current latrine promotion programmes do not reach all households equally. Joining a latrine programme was expensive and did not guarantee latrine ownership; this may cause people to lose trust in such programmes. Latrines were perceived to be useful, suggesting unmet demand. Reliable and inclusive programmes that provide low cost latrines may receive community support.