RESUMO
BACKGROUND: Drug overdose was the leading cause of injury and death in 2013, with drug misuse and abuse causing approximately 2.5 million emergency department (ED) visits in 2011. The Electronic Prescriptions for Controlled Substances (EPCS) program was created with the goal of decreasing rates of prescription opioid addiction, abuse, diversion, and death by making it more difficult to "doctor-shop" and alter prescriptions. OBJECTIVE: In this study, we describe the opioid-prescribing patterns of emergency physicians after the introduction of the New York State EPCS mandate. METHODS: We conducted a retrospective, single-center, descriptive study with a pre-/post-test design. The pre-implementation period used for comparison was April 1-July 31, 2015 and the post-implementation period was April 1-July 31, 2016. All ED discharge prescriptions for opioid medications prior to and after the initiation of New York State EPCS were identified. RESULTS: During the pre-implementation study period, 22,221 patient visits were identified with 1366 patients receiving an opioid prescription. During the post-implementation study period, 22,405 patient visits were identified with 642 patients receiving an opioid prescription. This represented an absolute decrease of 724 (53%) opioid prescriptions (p < 0.0001), which is an absolute difference of 2.3% (95% confidence interval 2.0-2.6%). CONCLUSIONS: There was a significant decline in the overall number of opioid prescriptions after implementation of the New York EPCS mandate.
Assuntos
Analgésicos Opioides/uso terapêutico , Prescrição Eletrônica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Adulto , Idoso , Overdose de Drogas/mortalidade , Overdose de Drogas/prevenção & controle , Registros Eletrônicos de Saúde/estatística & dados numéricos , Prescrição Eletrônica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York , Manejo da Dor/métodos , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Padrões de Prática Médica/legislação & jurisprudência , Padrões de Prática Médica/estatística & dados numéricos , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Estudos RetrospectivosRESUMO
CASE PRESENTATION: A 62-year-old male presented to the emergency department with altered mental status and fever. Computed tomography of the head showed enlargement of the left lateral ventricle. Magnetic resonance imaging demonstrated debris and purulence in the ventricle along with edema and transependymal flow of cerebrospinal fluid surrounding both ventricles. DISCUSSION: The patient was diagnosed with ventriculitis. Ventriculitis is an uncommon but serious disease. Early recognition and treatment are essential.