Computerized prescriber order entry and opiate prescription in ambulatory care visits

Objectives: To assess the impact of computerized prescriber order entry (CPOE) on opioid-prescribing practices. Methods: This study analyzed 233,390 office-based medical visits in the 2011-2015 National Ambulatory Medical Care Survey. We used survey-adjusted logistic regression analysis comparing prescription of opiate medications by physicians with and without CPOE. Results were adjusted by covariates describing patient demographics, insurance status, and geography; clinical factors including noncancer pain, cancer, and other chronic medical problems; and physician specialty category and solo practitioner status. Results: Opiates were prescribed in 10.4% of patient visits to physicians with access to CPOE in the sample, compared with 7.5% of visits to physicians without access to CPOE. The adjusted odds of opiate prescription were 1.35 times greater in visits to physicians who had access to CPOE (P = 0.001; 95% CI 1.14-1.58). Among patients visits citing pain (n = 52,978), the adjusted odds of opioid prescription were significantly greater when physicians had access to CPOE (odds ratio 1.28, 95% CI 1.02-1.61; P = 0.035). Conclusion: These findings support efforts to review and redesign embedded CPOE tools to improve guideline adherence and reduce problematic opiate prescription. Published by Elsevier Inc. on behalf of the American Pharmacists Association.