Emergency department attending physician variation in opioid prescribing in low acuity back pain

Jason A. Hoppe, Christopher McStay, Benjamin Sun, Roberta Capp

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1135-1142
Number of pages8
JournalWestern Journal of Emergency Medicine
Volume18
Issue number6
DOIs
StatePublished - Oct 1 2017

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Low Back Pain
Opioid Analgesics
Hospital Emergency Service
Physicians
Back Pain
Prescriptions
Guidelines
Internship and Residency
Emergencies
Retrospective Studies
Logistic Models
Therapeutics

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Emergency department attending physician variation in opioid prescribing in low acuity back pain. / Hoppe, Jason A.; McStay, Christopher; Sun, Benjamin; Capp, Roberta.

In: Western Journal of Emergency Medicine, Vol. 18, No. 6, 01.10.2017, p. 1135-1142.

Research output: Contribution to journalArticle

Hoppe, Jason A. ; McStay, Christopher ; Sun, Benjamin ; Capp, Roberta. / Emergency department attending physician variation in opioid prescribing in low acuity back pain. In: Western Journal of Emergency Medicine. 2017 ; Vol. 18, No. 6. pp. 1135-1142.
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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.",
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