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Emergency Department Attending Physician Variation in Opioid Prescribing in Low Acuity Back Pain.
West J Emerg Med. 2017 Oct; 18(6):1135-1142.WJ

Abstract

INTRODUCTION

Despite treatment guidelines suggesting alternatives, as well as evidence of a lack of benefit and evidence of poor long-term outcomes, opioid analgesics are commonly prescribed for back pain from the emergency department (ED). Variability in opioid prescribing suggests a lack of consensus and an opportunity to standardize and improve care. We evaluated the variation in attending emergency physician (EP) opioid prescribing for patients with uncomplicated, low acuity back pain (LABP).

METHODS

This retrospective study evaluated the provider-specific proportion of LABP patients discharged from an urban academic ED over a seven-month period with a prescription for opioids. LABP was strictly defined as (1) back pain chief complaint, (2) discharged from ED with no interventions, and (3) predefined discharge diagnosis of back pain. We excluded providers if they had less than 25 LABP patients in the study period. The primary outcome was the physician-specific proportion of LABP patients discharged with an opioid analgesic prescription. We performed a descriptive analysis and then risk standardized prescribing proportion by adjusting for patient and clinical characteristics using hierarchical logistic regression.

RESULTS

During the seven-month study period, 23 EPs treated and discharged at least 25 LABP patients and were included. Eight (34.8%) were female, and six (26.1%) were junior attendings (≤ 5 years after residency graduation). There were 943 LABP patients included in the analysis. Provider-specific proportions ranged from 3.7% to 88.1% (mean 58.4% [SD +/- 22.2]), and we found a 22-fold variation in prescribing proportions. There was a six-fold variation in the adjusted, risk-standardized prescribing proportion with a range from 12.0% to 78.2% [mean 50.4% (SD +/-16.4)].

CONCLUSION

We found large variability in opioid prescribing practices for LABP that persisted after adjustment for patient and clinical characteristics. Our findings support the need to further standardize and improve adherence to treatment guidelines and evidence suggesting alternatives to opioids.

Authors+Show Affiliations

University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado.University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado.Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon.University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29085548

Citation

Hoppe, Jason A., et al. "Emergency Department Attending Physician Variation in Opioid Prescribing in Low Acuity Back Pain." The Western Journal of Emergency Medicine, vol. 18, no. 6, 2017, pp. 1135-1142.
Hoppe JA, McStay C, Sun BC, et al. Emergency Department Attending Physician Variation in Opioid Prescribing in Low Acuity Back Pain. West J Emerg Med. 2017;18(6):1135-1142.
Hoppe, J. A., McStay, C., Sun, B. C., & Capp, R. (2017). Emergency Department Attending Physician Variation in Opioid Prescribing in Low Acuity Back Pain. The Western Journal of Emergency Medicine, 18(6), 1135-1142. https://doi.org/10.5811/westjem.2017.7.33306
Hoppe JA, et al. Emergency Department Attending Physician Variation in Opioid Prescribing in Low Acuity Back Pain. West J Emerg Med. 2017;18(6):1135-1142. PubMed PMID: 29085548.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency Department Attending Physician Variation in Opioid Prescribing in Low Acuity Back Pain. AU - Hoppe,Jason A, AU - McStay,Christopher, AU - Sun,Benjamin C, AU - Capp,Roberta, Y1 - 2017/09/18/ PY - 2016/12/09/received PY - 2017/06/30/revised PY - 2017/07/06/accepted PY - 2017/11/1/entrez PY - 2017/11/1/pubmed PY - 2018/3/23/medline SP - 1135 EP - 1142 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 18 IS - 6 N2 - INTRODUCTION: Despite treatment guidelines suggesting alternatives, as well as evidence of a lack of benefit and evidence of poor long-term outcomes, opioid analgesics are commonly prescribed for back pain from the emergency department (ED). Variability in opioid prescribing suggests a lack of consensus and an opportunity to standardize and improve care. We evaluated the variation in attending emergency physician (EP) opioid prescribing for patients with uncomplicated, low acuity back pain (LABP). METHODS: This retrospective study evaluated the provider-specific proportion of LABP patients discharged from an urban academic ED over a seven-month period with a prescription for opioids. LABP was strictly defined as (1) back pain chief complaint, (2) discharged from ED with no interventions, and (3) predefined discharge diagnosis of back pain. We excluded providers if they had less than 25 LABP patients in the study period. The primary outcome was the physician-specific proportion of LABP patients discharged with an opioid analgesic prescription. We performed a descriptive analysis and then risk standardized prescribing proportion by adjusting for patient and clinical characteristics using hierarchical logistic regression. RESULTS: During the seven-month study period, 23 EPs treated and discharged at least 25 LABP patients and were included. Eight (34.8%) were female, and six (26.1%) were junior attendings (≤ 5 years after residency graduation). There were 943 LABP patients included in the analysis. Provider-specific proportions ranged from 3.7% to 88.1% (mean 58.4% [SD +/- 22.2]), and we found a 22-fold variation in prescribing proportions. There was a six-fold variation in the adjusted, risk-standardized prescribing proportion with a range from 12.0% to 78.2% [mean 50.4% (SD +/-16.4)]. CONCLUSION: We found large variability in opioid prescribing practices for LABP that persisted after adjustment for patient and clinical characteristics. Our findings support the need to further standardize and improve adherence to treatment guidelines and evidence suggesting alternatives to opioids. SN - 1936-9018 UR - https://www.unboundmedicine.com/medline/citation/29085548/Emergency_Department_Attending_Physician_Variation_in_Opioid_Prescribing_in_Low_Acuity_Back_Pain_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/29085548/ DB - PRIME DP - Unbound Medicine ER -