The Reducere™ application is easy to use, pristinely accurate, and functions quickly by providing results within seconds of the initial query. There is nothing that is going to be more accurate in terms of creating a proper tapering schedule.
Practitioners simply enter the medication, dose, frequency, and select the desired taper rate. The application then outputs an elegant, accurate, and easy-to-follow schedule that will not leave anything to question for the future of practitioners and their patients.
Reducere™ is an invaluable tool that can protect physicians and patients during the national transition away from opioids. Specifically it provides a definite plan that can be placed in the medical record and can guard against tapering too fast.
Available on both iOS and Android, Reducere™ is for practitioners to reference when prescribing an opioid tapering schedule to their patients
[00:00] overview of the application and its vital features
[02:10] detailed explanation of the output schedule
[04:30] live use of the application
[05:10] desired end date feature
[07:00] comparison to calculations by hand
[08:20] future tutorials
Full transcription directly below
[Dr Beno Kuharich] This is a walkthrough of Reducere, some of its features, why it's valuable, and how this app can do in about 20 seconds what could potentially take providers 50 hours a year.
Start the application, it goes right to the work screen. There's no notifications, there's no ads, there's nothing that impedes your workflow. Start by entering the opioid. Auto-populates every opioid that's on the market that's relevant to this app.
We're gonna select long acting morphine and it's a very common medication. Very next screen, select the dose. We'll say this patient's on 60 milligrams.
So here I want to point out that this app is not just reducing the dose of the medication, and that's also not the best way to taper opioids. So if you look at any of the guidelines, they're gonna say to start around 10% in terms of tapering opioids. Some of them even say 5%.
You're not gonna see any guideline out there that says, decrease to the next lowest dose or decrease by 50%. If you do this, if you go from 60 to 30 milligrams in all these doses and cut your patient's medications in half, you're gonna have more than likely significant withdrawal symptoms and end up prescribing other medications for those withdrawal symptoms and then you can get into a situation of polypharmacy, and these other medications have their own side effects, and that's just not needed if you're doing a proper opioid taper at the suggested tapering rates.
So we're gonna select 60 milligrams, and we're gonna say this patient takes one tablet three times a day. A very reasonable, a very common way to take this medication in current times. Next, we just select the refill date or when you want the taper to start. We're gonna say that this patient's refill date is on the 23rd, so that's when this taper is gonna start.
The next screen asks how fast we want to taper this medication. Reminds us that it's a long acting medication, some options that are very typical for tolerable tapers of long acting medications. So we're just gonna select 10%, consistent with a lot of guidelines, and we're gonna say this patient has a 28 day refill interval, so every 28 days.
[02:10] Calculates the schedule. Initially it tells us how many days this is gonna occur over, or how long it will take to taper completely off these medications at 10% every 28 days, and we're gonna view the schedule.
Couple things I want to point out here. Again, it gives us the current prescription, the tapering rate we've selected, how long this is gonna take to go through the entire tapering schedule. This is the most accurate way to create an opioid tapering schedule. So we're gonna go to the first interval here. This is when we start the taper. This is the 28 day interval.
So it's gonna show us a couple of things here. Number one, it's gonna show us how the patient is gonna take the medications for this first interval. You notice the first dose, dose one, is still 60 milligrams. One 30 milligram tablet and two 15s, 60 milligram. The next dose is gonna go down to 45 milligrams. A 30 and a 15, same with the third dose. One thing that Reducere does that's extremely valuable is it calculates the lowest common denominator of dosing units required to fulfill each month's prescription.
In other words, it's not asking you to write one prescription of 60 milligram, and another prescription of 30 milligram, and another prescription of 15 milligram. It's calculating this so you can only write two prescriptions. Again, this is a time saver.
Takes us to the next month of this person's taper. Again, you'll see here the same thing's been calculated for you. How many dosing units need to be prescribed during this 28 day period. We'll examine this a little closer. First dose 45 milligrams. 45 milligrams, 45 milligrams. Three times a day. Go to the next month. Again, same thing. The dates are well defined. You know when to dispense the medication. You know how much to dispense and the patient's gonna take 45, 45 and 30. We can follow this all the way down until ultimately at the end of the taper they take it once a day, lowest dose, and then they're off the medication.
So once you have the schedule, all you do, print or email it. You can email it to your assistant to put in the chart. You can also CC the patient, or you can print it out and give a copy to the patient and for the medical record. Very, very easy. So in terms of how much time this can save a practice or a physician, or any provider, or a large medical organization.
[04:30] Let's just back up and use the app all the way through without talking about it. So once you're here, you don't have to do anything except select a new opioid. We're just gonna use the same example. Now I'm gonna do morphine long acting. Again, 60 milligrams. One tablet three times a day. Again this patient's refill is gonna be on the 23rd. We already know we want to decrease by 10% every 28 days. Here's the schedule. It's ready to go. It's ready to send to whoever you're gonna send it to, the patient and your medical record most likely, and that took somewhere less than 20 seconds.
[05:10] So I just want to highlight another feature of the app right now. Let's select a new medication, and let's say you have a patient who needs to be off of opioids in a specific timeframe. Let's say your patient is gonna have a hip surgery or something else that requires them to be off of these medications in a specific timeframe.
So let's do another example. We'll do oxycodone. Very common medication. Let's say a patient's on 20 milligrams, one tablet four times a day. And we're gonna select their next refill date. Let's say it's also gonna be on the 23rd, it can be any date. And instead of creating a tapering schedule based on a percentage, let's say we know that this patient wants to be off of opioids on a specific day. So we're gonna select a desired end date. Let's say that in six months from now this patient needs to be off opioids. So we're gonna go February, March, April, May, June, July. Let's say by July 23rd this patient needs to be off opioids.
We know one thing right away, that this follows usual tapering guidelines with little to no withdrawal symptoms, and we're just gonna see the schedule. We know it's gonna take what we've selected, 140 days, will actually be somewhat less than six months, and it's gonna reduce the medication 17% every two weeks.
We can view the schedule and here it is. First two week interval scheduled it most closely approximates our tapering. Again, the first dose is still gonna be 20 milligrams. The second three are gonna go down to 15 and so forth over the course of this taper during the dedicated time frame, until the patient is on one a day and they can stop the medication.
You can give this schedule, again, to the patient, you can send it to the surgeon so they know that there is a definite plan to have this patient off opioids, and you can also easily put it in the medical record.
[07:00] So I want to point out the time saving features of this application. Let's say that it's a typical primary care practice. It's not unreasonable to think that many primary care practices have at least 50 patients on opioids, and let's say you're gonna taper patients off of opioids over the next year.
So if you have 50 patients and you're seeing them every two months, that's about 600 office visits per year. And let's say you're using Reducere. Well we just showed that we calculate the tapering schedule for the entire duration of the opioid taper in about less than 20 seconds. So if you're gonna do this without any technological assistance, let's just use the example of having 50 patients, and let's say it takes five minutes to calculate the next prescription and when it needs to be filled, and for how many days, and the number of dosing units, and let's say that takes 5 minutes.
So let's take the example of using 50 patients, you're gonna be seeing them every two months. That's 600 office visits per year. If you spend five minutes calculating their next prescription, that comes out to be 3,000 minutes a year that a provider is spending calculating these tapering schedules, and that's 50 hours a year. So that's over a week of professional productive time that you're spending doing these calculations.
Even if you're used to doing this and you do this a lot, let's say it takes two minutes to calculate the next refill. You're still looking at 1,200 minutes a year, when you can have the entire tapering schedule done in less than 20 seconds.
[08:20] Additional features that will be examined on future tutorials include notifications to guard against potentially too rapid of a taper, and also safety measures that are built in, including limits on medications with sealing doses such as acetaminophen or ibuprofen.