Electronic Prescribing Effects Opioid Prescription Fill Rates After Dermatologic Surgery

Pill bottles lined up
Opioid prescribing and filling patterns before and after the implementation of the Electronic Prescribing of Controlled Substances (EPSC) program are compared.

After the Electronic Prescribing of Controlled Substances (EPSC) program was implemented in Pennsylvania, post-surgery opioid prescription filling rates decreased even as prescribing rates did not change, according to study data published in the Journal of the American Academy of Dermatology.

Investigators conducted a retrospective chart review of adult patient single-site Mohs micrographic surgery (MMS). They compared opioid prescriptions rates before EPCS implementation (August 20-December 24, 2019; “pre-intervention”) and after EPCS implementation (October 25-December 29, 2019; “post-intervention”). They used the Prescription Drug Monitoring Program (PDMP) to connect patients’ surgical encounters to filled opioid scripts. Pre- and post-intervention opioid prescription rates (OPR) and patient opioid fill rates (POFR) were calculated and the investigators compared them using Pearson’s squared test.

Of 904 surgical encounters that met the inclusion criteria for the study, the majority of patients were men; the mean age was about 68 years. In total, 175 patients received post-op opioid prescriptions overall, 55% of which were filled.

Pre- and post-intervention OPRs were 20.4% and 18.0%, respectively, with an absolute decrease of 2.4% and a percent decrease of 11.8% (P =.374). Pre- and post-intervention POFRs were 62.6% and 44.3%, respectively, with an absolute decrease of 18.3% and a percent decrease of 29.2% (P =.018).

The study was limited by its single tertiary care setting and the lack of corresponding patient-reported pain levels.

The study authors posited several reasons for the decrease in POFRs despite no significant change in providers’ prescribing rates. They noted that as the electronic prescription is not a physical paper, patients do not have a physical reminder to fill it, nor do they fill it due to the fear of losing the paper prescription. In this way, unnecessary opioids remain in pharmacies and not in patients’ homes. This also positions electronic POFR as a better indicator of true opioid consumption, they suggested.

“The implementation of electronic prescriptions is a successful quality improvement measure to decrease the number of opioids filled by patients after dermatologic surgery,” investigators wrote.


Aizman L, Veerabagu S, Cheng B, et al. Impact of electronic prescribing on issued and filled opioid prescriptions following Mohs micrographic surgery. J Amer Acad Derm. Published online February 15, 2022. doi:10.1016/j.jaad.2022.02.031