Opioid stewardship program implementation in rural and critical access hospitals in Arizona.

Objective: The objective of this study is to examine rural hospitals' status in implementing opioid stewardship program (OSP) elements and assess differences in implementation in emergency department (ED) and acute inpatient departments.

Design: Health administrator survey to identify the number and type of OSP elements that each hospital has implemented.

Setting: Arizona critical access hospitals (CAHs).

Participants: ED and acute inpatient department heads at 17 Arizona CAHs (total of 34 assessments).

Main Outcome Measures: Implementation of 11 OSP elements, by department (ED vs inpatient) and prevention orientation (primary vs tertiary).

Results: The percentage of implemented elements ranged from 35 to 94 percent in EDs and 24 to 88 percent in acute care departments. Reviewing the prescription drug monitoring program database and offering alternatives to opioids were the most frequently implemented. Assessing opioid use disorder (OUD) and prescribing naloxone were among the least. The number of implemented elements tended to be uniform across departments. We found that CAHs implemented, on average, 67 percent of elements that prevent unnecessary opioid use and 54 percent of elements that treat OUD.

Conclusions: Some OSP elements were in place in nearly every Arizona CAH, while others were present in only a quarter or a third of hospitals. To improve, more attention is needed to define and standardize OSPs. Equal priority should be given to preventing unnecessary opioid initiation and treating opioid misuse or OUD, as well as quality control strategies that provide an opportunity for continuous improvement.