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Opioid Prescriptions: Perception vs. Reality

May 29th, 2018

New research may surprise clinicians who believe they know precisely how many opioids they’ve prescribed in the last six to 12 months.

A study published in Academic Emergency Medicine found that self‐perception of prescribing was frequently inaccurate among emergency department clinicians.

Researchers from the University of Colorado Denver School of Medicine hypothesized that future prescribing would be affected if researchers asked ED providers to reveal their opioid prescribing habits and then informed those providers of their actual prescribing practices compared to group norms.

The study team determined that ED providers who initially underestimated opioid prescription rates demonstrated statistically significant decreases in prescriptions when compared to colleagues whose self-assessment was more accurate.

For the prospective, multicenter, randomized trial, researchers randomly assigned all attending physicians, residents, and advanced practice providers at four EDs (109 total participants) to either no intervention or to a brief data‐driven intervention. During the intervention, clinicians were asked to describe their perceived opioid prescribing practices compared to peers. Then investigators provided the clinicians with actual comparison data.

The primary outcome was defined as the adjustment in providers’ proportion of patients discharged with a prescription for opioids at six and 12 months. The researchers used opioid prescriptions per 100 total prescriptions and normalized morphine milligram equivalents prescribed as secondary outcomes.

Results indicated that 65% of ED providers in the intervention group underestimated their opioid prescribing. Investigators noted that intervention participants who underestimated their baseline prescribing logged larger‐magnitude decreases than controls (Hodges‐Lehmann difference = -2.1 prescriptions per 100 patients at six months [95% CI, -3.9 to -0.5] and -2.2 per 100 at 12 months [95% CI, -4.8 to -0.01]).

At the same time, intervention participants who did not underestimate prescribing habits demonstrated similar changes to control participants.

“Self‐perception of prescribing was frequently inaccurate. Providing clinicians with their actual opioid prescribing data after querying their self‐perception reduced future prescribing among providers who underestimated their baseline prescribing,” the study authors concluded. “Our findings suggest that guideline and policy interventions should directly address the potential barrier of inaccurate provider self‐awareness.”