The effectiveness of a multisite, multidisciplinary analgesic stewardship program: a 12-month retrospective cohort study

Abstract Introduction: Safe and judicious use of opioids is essential for effective pain management and reducing associated harm. Objectives: We examined the effectiveness of a multisite, multidisciplinary analgesic stewardship program comprising of both organisation- and patient-level interventions (intervention) compared with organisation-level interventions alone (control). Methods: This retrospective cohort study included adult inpatients who were either opioid-naïve at preadmission and prescribed a modified-release opioid (opioid-naïve cohort; n = 183) or nonopioid-naïve at preadmission (nonopioid-naïve cohort; n = 577). The primary outcomes were discharge on a modified-release opioid (opioid-naïve cohort), change in oral morphine equivalent daily dose from preadmission to discharge (nonopioid-naïve cohort), and readmission within 2 weeks (both cohorts). Data were collected at preadmission and discharge over 12 months (August 2022 to July 2023). Results: Patients (n = 760, female: 63%) had a mean (SD) age of 71.9 (19.1) years and a hospital length of stay of 11.0 (14.6) days. Among the opioid-naïve cohort, the intervention led to a between-group reduction in discharge on modified-release opioids (OR 95% CI: 0.23 0.11–0.49, P < 0.001), yet not readmission within 2 weeks (OR 95% CI: 0.76 0.08–7.45, P = 0.813). Among the nonopioid-naïve cohort, the intervention led to a between-group reduction in readmission within 2 weeks (OR 95% CI: 0.39 0.15–0.98, P = 0.045), yet not oral morphine equivalent daily dose (estimated marginal mean net difference 95% CI: −7.46 −16.74 to 1.82 mg, P = 0.115). Conclusion: A multisite, multidisciplinary analgesic stewardship program comprising both organisation- and patient-level interventions may lead to better opioid prescribing at discharge and potentially clinically meaningful reductions in readmission when compared with organisation-level interventions alone.