By Christina Jones, Policy Analyst, OntarioMD
Opioid-related harms continue to be an ongoing epidemic health care providers and policymakers are striving to remedy. The experience of the COVID-19 pandemic brought forward the significance of social determinants of health (SDOH) in connection with opioid use, as its effects vary across geographical regions, socioeconomic status and urban versus rural populations.
IMPORTANCE OF SDOH FOR OPIOID MANAGEMENT STRATEGIES
In Ontario during the first three months of the pandemic, a 38% increase in opioid-related deaths occurred between March 16 and June 30, 2020, compared to the three months priori.
The economic and social impacts of the COVID-19 pandemic has emphasised the need for greater focus on integrating SDOH into management strategies to better address and alleviate the disparities that influence opioid-related harms.
Across Ontario, most people dispensed opioids were in urban settings, with prescription indications most common for cough, versus in rural areas where the most prevalent reason was to treat painii. The pandemic worsened opioid-related deaths in at-risk populations as it more than doubled among people experiencing homelessness to 1 in 6 deathsiii.
Differences in the indications for opioid prescription, and the characteristics of populations who use opioids, can help us understand how opioid effects vary across different groups.
THE ROLE OF EMR SYSTEMS AND DIGITAL HEALTH TOOLS
The move towards digitizing health care with the wide use of electronic medical record (EMR) systems such as ePrescriptions have been employed as a tool to manage opioid distribution and use. When entering prescriptions through an EMR system, a default number of pills is auto-populated for the clinician, which forces the provider to “actively increase the amount if they believe it is necessary”iv. Prescribing habits could be changed by way of the mode in which prescriptions are filled out, completed, and monitored.
At federal and provincial levels, progress has been made in leveraging digital health tools to monitor and manage the use and prescription of drugs, including opioids, across populations.
Canada Health Infoway has been working with Health Canada, the provinces and territories, industry stakeholders, retailers, and other private sector companies to design, build and operate the technology infrastructure for PrescribeIT®, a multi-jurisdiction e-prescribing solution that enables prescribers to electronically transmit a prescription to a patient’s pharmacy of choice.
PrescribeIT® provides safer and more effective medication management. By connecting prescribers through their existing EMR systems, to community retail pharmacies through their existing pharmacy management system, PrescribeIT® enables the electronic transmission of prescriptions, including narcotics.
Digital Health Drug Repository
The Digital Health Drug Repository (DHDR) is a provincial information source of publicly funded drug and pharmacy services and all monitored drugs (regardless of payor). DHDR data supports optimal patient care by providing authorized clinicians real-time, secure, electronic access to information on:
- Publicly funded drugs, including those paid for by the Ontario Drug Benefit (ODB) program
- Monitored drugs (narcotics and controlled substances), including opioids
- Publicly funded pharmacy services, such as the MedsCheck Program medication reviews and pharmacist-administered influenza vaccines
- COVID-19 vaccination information documented in COVaxON, the provincial vaccination management system
OntarioMD (OMD) is leading EMR integration with the DHDR in partnership with Ontario Health, the Ministry of Health, and vendors with OMD-certified EMRs, so Ontario clinicians can conveniently access patients’ drug histories through their EMRs.
By the end of November 2022, EMR-Integrated DHDR will be available to all clinicians who use an EMR certified by OMD. Clinicians, whose EMR vendors have already completed the integration, have already begun to adopt the tool.
The use of digital health tools is a crucial piece of the multi-faceted solution that is necessary to alleviate the opioid crisis. As the pandemic has expanded the adoption of digital health tools, including virtual care, it is key they are leveraged to their fullest to provide clinicians access to the important information they need to deliver quality care, prevent adverse drug events such opioid overdoses, and improve health outcomes.