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How to Change Opiate Prescribing Habits

April 2, 2018

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Emergency clinicians who underestimated their own opiate prescribing were impacted more profoundly to reduce prescriptions by being shown their opiate prescribing data compared to their peers.

Why does this matter?
Peer comparison is a good way to help clinicians assess and improve prescribing habits, both with controlled substances and antibiotics.  Prior to this study, we didn’t know how a wrong view of one’s own prescribing affected this.  Would those who thought they were doing well but were not be more responsive?

Pride goes before a fall in opiate prescriptions
This was a RCT of 109 attending, resident, and advanced practice clinicians at 4 EDs.  Of these, 51 were randomized (42 analyzed) to an intervention consisting of a self-assessment survey of their own opiate prescribing habits.  They were then shown their actual opiate prescribing compared with their peers.  The others were the control group (58 randomized, 41 analyzed) and had no form of intervention.  Of the 42 in the intervention group, 27 (65%) underestimated their opiate prescribing.  Compared to controls, they had a bigger drop in number of opiate prescriptions (2.2 per 100 patients at 12 months).  Those who accurately estimated their opiate prescribing saw a slightly lower drop than controls.  Overall, everyone dropped, so there may have been cross contamination coupled with a government push to reduce prescribing.  Why did those who underestimated have a bigger drop in prescriptions than controls?  The authors postulate that the cognitive dissonance felt by those who thought they were doing better than they actually were may have spurred this.  It is notable that those who did not underestimate prescribing actually had more prescriptions than the control group.  This indicates that the feedback may have had the unintended consequence of causing them to become less stringent when writing new opiate prescriptions.

Effect of a Data-Driven Intervention on Opioid Prescribing Intensity Among Emergency Department Providers: A Randomized Controlled Trial.  Acad Emerg Med. 2018 Mar 2. doi: 10.1111/acem.13400. [Epub ahead of print]

Peer reviewed by Thomas Davis.

What are your thoughts?