The current opioid crisis, including prescription opioid misuse, abuse, and associated overdose deaths, represents a major public health issue. Wisconsin has been hard-hit by this public health crisis, with opioid-related death rates in recent years that were almost double the national average.
Jefferson County, a rural county located in Southeastern Wisconsin and with a population of approximately 85,000 people, has been severely impacted by the opioid crisis. In 2017 the death rate due to opioids was 21.3/100,000 population, roughly 81% higher than the rate in Wisconsin. Between 2015 and 2017, the death rate/100,000 population due to opioids nearly tripled in Jefferson County, increasing from 8.3 to 21.9 There is a critical need to address the opioid crisis in Jefferson County.
Many of these tragic events involved the unsafe use or abuse of prescription opioid medications (opioids), and efforts to reduce overdose and death require a broad-based approach matching the complex nature of today’s opioid crisis. More comprehensive approaches yield a greater likelihood of success.
In response to the opioid crisis, the US Department of Health and Human Services introduced and advocated for the concept of an opioid stewardship program (OSP) in 2017. Modeled after antibiotic stewardship programs, an OSP should address opioid prescribing, facilitate treatment of opioid use disorder (OUD), provide patient education about proper use of opioids, and leverage information technology (IT) tools to implement and evaluate the impact of an OSP. Joint Commission standards required hospitals to implement an OSP for inpatients starting January, 2018.
Despite these requirements, less than half of hospitals reported having implemented an active OSP. OSP initiatives to improve opioid prescribing by providers are challenging to implement because of the difficulty in accessing and presenting, in a useful way, information about patients’ past drug use patterns to providers to inform prescribing decisions. Providers do not have the mental capacity or time to obtain and integrate all relevant patient information necessary for optimally informing their prescribing decisions. Furthermore, although OSP initiatives should have broad reach and impact, they typically are implemented with a narrow and specific focus and do not cross the continuum of care. Developing OSP initiatives that are integrated into electronic health records (EHRs) presents an opportunity to automate a cognitively challenging and information scarce process and facilitates the sharing of information throughout the health system.
Fort HealthCare (FHC), the primary health care system and only hospital in Jefferson County, recognized the critical need to address the opioid crisis in Jefferson County. Since 2019, Dr. Chui and her research team have partnered with Fort HealthCare and the Pharmacy Society of Wisconsin on projects surrounding Fort HealthCare and opioid stewardship initiatives, centered around an electronic health record clinical decision support tool.