30 Aug Doctors More Likely To Prescribe Opioids When They Are Running Late
MedicalResearch.com Interview with:
Dr. Hannah T. Neprash, PhD
Assistant Professor, Division of Health Policy and Management
School of Public Health
University of Minnesota
MedicalResearch.com: What is the background for this study?
Response: Physicians play a pivotal role in the opioid epidemic and it’s important to understand what factors that drive opioid prescribing. Variation in opioid prescribing across physicians has been well-documented, but there’s very little research on variation within physicians…which is surprising, given the widespread concern about time pressure and cognitive fatigue having a potentially detrimental effect on the quality of care provided by physicians.
MedicalResearch.com: What are the main findings?
Response: We looked at a common reason given for overprescribing of opioids – doctors don’t have “enough time” to do the kind of discussion necessary to manage pain without opioids. We figured that we might see more of this time pressure as the day got later and as appointments ran behind. Using a national EHR dataset with >5000 physicians, we saw exactly that pattern.
Doctors were 33% more likely to prescribe an opioid at the end of the day vs. the beginning of the day, and 17% more likely for appointments running 60+ minutes behind vs. those on time. (Note: these are large relative differences, but fairly modest absolute differences [a 1 to 1.5 percentage point increase], since opioid prescribing is pretty low for this group of patients already.) We didn’t see this pattern for non-opioid pain treatments like non-steroidal drugs or physical therapy.
MedicalResearch.com: What should readers take away from your report?
Response: Doctors are modestly more likely to prescribe opioids later in the day and when they’re running late. If similar patterns exist for other clinical decisions, this suggests that time pressure in medicine may affect how physicians provide patient care.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further research is needed to understand whether similar patterns exist for other clinical decisions, like antibiotic prescribing and managing chronic illness. If so, this phenomenon could have widespread relevance for public health and quality improvement efforts.
No disclosures to report.
Neprash HT, Barnett ML. Association of Primary Care Clinic Appointment Time With Opioid Prescribing. JAMA Netw Open. Published online August 30, 20192(8):e1910373. doi:10.1001/jamanetworkopen.2019.10373
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Last Updated on August 30, 2019 by Marie Benz MD FAAD