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Many ED doctors underestimate how many opioids prescribed

Sean Michael

Nearly two-thirds of ED doctors incorrectly estimated how many opioids they prescribed, according to findings recently published in Academic Emergency Medicine.

A study author told Healio Family Medicine the results are not unique to ED doctors.

“Many medical professionals are doing what they think is best, and in their patients’ best interest. Yet, despite all the commentary and all the guidelines that have come out regarding opioids in the past few years, many may still be prescribing far more or less than their colleagues,” Sean Michael, MD, assistant professor of emergency medicine at the University of Colorado School of Medicine, told Healio Family Medicine. “We wanted to provide some information to help them decide if they want to change their behavior.”

Researchers randomly assigned 109 attending physicians, residents and advanced practice providers in four EDs to no intervention or a brief data-driven intervention. The intervention group was asked to self-identify and specifically report their assumed opioid prescribing vs. their colleagues. These medical professionals then received their actual data along with peer group norms.

Michael and colleagues found that of the 51 doctors who received the intervention, 65% underestimated their opioid prescribing. At 6 months, intervention participants who underestimated their baseline prescribing had larger-magnitude decreases than controls (2.1 fewer prescriptions per 100 patients; 95% CI, –3.9 to –0.5) and at 12 months (2.2 fewer per 100 patients; 95% CI, –4.8 to –0.01). Intervention participants who did not incorrectly estimate their prescribing had similar changes to controls.

“We expected the distribution would run the spectrum. However, we had to rethink our analysis plan because, to our surprise, almost no one thought they were prescribing more than they actually were. Almost everyone thought they were prescribing less than they really were. In retrospect, it seems obvious, but at the time, we truly thought that between participants’ mindsets and their actual practices, participants would be accurate,” Michael said in the interview.

“Though we only studied in an ED setting, we saw nothing that suggested there would be any differences if the study had been conducted among primary care physicians or family physicians,” he added.

Michael also discussed potential ways to bring the medical professionals’ prescribing mindsets and the reality more in sync.

“We need to look in the mirror to make it easier to understand our prescribing patterns in a data-driven way. That way we are comparing ourselves to others in the community and nationally and can have a thoughtful reflection. It is hard to do this with EHRs and many existing guidelines,” he said.

“In addition, the medical community needs to stop assuming that broadcasting the same message to all physicians will work and will sufficiently change their behavior. I’m not trying to diminish the CDC and other medical societies’ important work toward developing guidelines, but when we publish them, we assume providers will read and internalize them and change their behavior. But that isn’t the case,” Michael said.

“It’s similar to how we all think we are all above-average drivers. Most of us think we are below-average prescribers, so when we see guidelines, we think, ‘Yeah, I am following those, so the opioid crisis is being driven by other people.’ There are prescribers who may think they are doing the right thing, but this study provides some information that suggests that they may want to change their behavior, based on how they stack up among their peers,” he said. – by Janel Miller

Disclosures: Michael reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.