Association of Primary Care Clinic Appointment Time With Opioid Prescribing

Neprash, Hannah T.; Barnett, Michael L.

doi:10.1001/jamanetworkopen.2019.10373

Cited by 55 publications

(48 citation statements)

References 25 publications

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“…59 Comparable findings were observed for the prescription of opioids as well. 60 Similarly, one study found that clinicians' ordering of cancer screening tests decreased as the workday progressed. 61 Outside of healthcare, studies of how judges make decisions about parole, sentence lengths, and immigration have found that their decisions are sensitive to extraneous factors, including taking a food break, experiencing unexpected losses of football games, and an increase in outdoor temperature.…”

Section: Discussionmentioning

confidence: 98%

“…For example, one study found that clinicians are more likely to prescribe antibiotics to patients with upper respiratory tract infections as the workday progresses, probably because the cumulative cognitive demand of clinical decisions progressively impairs clinician’s ability to avoid clinically inappropriate decisions 59. Comparable findings were observed for the prescription of opioids as well 60. Similarly, one study found that clinicians’ ordering of cancer screening tests decreased as the workday progressed 61.…”

Section: Discussionmentioning

confidence: 99%

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Patient mortality after surgery on the surgeon’s birthday: observational study

Kato

Jena

Tsugawa

2020

BMJ

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Objective To determine whether patient mortality after surgery differs between surgeries performed on surgeons’ birthdays compared with other days of the year. Design Retrospective observational study. Setting US acute care and critical access hospitals. Participants 100% fee-for-service Medicare beneficiaries aged 65 to 99 years who underwent one of 17 common emergency surgical procedures in 2011-14. Main outcome measures Patient postoperative 30 day mortality, defined as death within 30 days after surgery, with adjustment for patient characteristics and surgeon fixed effects. Results 980 876 procedures performed by 47 489 surgeons were analyzed. 2064 (0.2%) of the procedures were performed on surgeons’ birthdays. Patient characteristics, including severity of illness, were similar between patients who underwent surgery on a surgeon’s birthday and those who underwent surgery on other days. The overall unadjusted 30 day mortality on the operating surgeon’s birthday was 7.0% (145/2064) and that on other days was 5.6% (54 824/978 812). After adjusting for patient characteristics and surgeon fixed effects (effectively comparing outcomes of patients treated by the same surgeon on different days), patients who underwent surgery on a surgeon’s birthday exhibited higher mortality compared with patients who underwent surgery on other days (adjusted mortality rate, 6.9% v 5.6%; adjusted difference 1.3%, 95% confidence interval 0.1% to 2.5%; P=0.03). Event study analysis of patient mortality by day of surgery relative to a surgeon’s birthday found similar results. Conclusions Among Medicare beneficiaries who underwent common emergency surgeries, those who received surgery on the surgeon’s birthday experienced higher mortality compared with patients who underwent surgery on other days. These findings suggest that surgeons might be distracted by life events that are not directly related to work.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Patient mortality after surgery on the surgeon’s birthday: observational study

Kato

Jena

Tsugawa

2020

BMJ

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“…21 22 Patients in such circumstances could find themselves pressured into detrimental patterns of self-medication and delayed healthcare access. Consequently, 'quick fix' solutions such as self-medication or antibiotic purchase without prescriptions can be interpreted as default strategies to cope with adversity, [23][24][25] or perhaps even as 'performance enhancers'. 26 Precarity could therefore challenge the underlying assumptions and ultimately the effectiveness of public awareness campaigns that form the backbone of global AMR strategies ('Only take antibiotics prescribed to you').…”

Section: What Are the New Findings?mentioning

confidence: 99%

Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand

et al. 2020

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BackgroundThe social determinants of health are a decisive yet persistently understudied area for tackling global health challenges like antimicrobial resistance (AMR). Precarity is one determinant whose importance is increasingly recognised, which we define here as ‘a form of pernicious self-dependence that undermines individuals’ control over their own lives and limits their ability to flexibly respond to crises’. We aimed to assess the relationship between precarity, other forms of deprivation and healthcare-seeking behaviour by asking, ‘What is the impact of precarity, marginalisation and clinical presentation on healthcare-seeking behaviour?’ and ‘Do patients experiencing precarious livelihoods have clinically less advisable healthcare-seeking behaviour?’MethodsWe used healthcare-seeking behaviour census survey data from rural Thailand and Laos, wherein five rural communities were surveyed two times over a period of 3 months (2-month recall period). Using descriptive statistical and multivariate logistic regression analysis on the illness level, we studied precarity alongside clinical presentation, marginalisation and facilitating solutions during an illness (eg, health-related phone use) as determinants of healthcare-seeking behaviour in the form of healthcare access and antibiotic use.ResultsThe data included 1421 illness episodes from 2066 villagers. Patients in precarious circumstances were up to 44.9 percentage points more likely to misuse antibiotics in the presence of situational facilitators (predicted antibiotic misuse: 6.2% (95% CI: 0.9% to 11.4%) vs 51.1% (95% CI: 16.6% to 85.5%) for precarious circumstances with/without facilitation). Marginalisation was linked to lower antibiotic use, but this did not translate into clinically more advisable behaviour. Clinical presentation played only a minor role in determining healthcare access and antibiotic use.ConclusionsThis study underlines the importance of context and local livelihoods in tackling drug resistance. While supporting the growing emphasis on AMR-sensitive development policy, we call for future research to study systematically the healthcare-seeking behaviour impact of precarious livelihoods, social policy and community development initiatives.Trial registration numberNCT03241316.

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“…Institutional constraints also play a role in doctors’ treatment decisions. Some evidence suggests that doctors are more likely to over-treat pain during periods of increased time-pressure, such as when it is late at night or when emergency departments are crowded [ 15 , 23 ]. Such time constraints may intensify doctors’ implicit biases by increasing their likelihood to rely on implicit assumptions about patient diagnostic categories to inform treatment [ 13 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Provider Bias in prescribing opioid analgesics: a study of electronic medical Records at a Hospital Emergency Department

Keister

Stecher

Aronson³

et al. 2021

BMC Public Health

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Background Physicians do not prescribe opioid analgesics for pain treatment equally across groups, and such disparities may pose significant public health concerns. Although research suggests that institutional constraints and cultural stereotypes influence doctors’ treatment of pain, prior quantitative evidence is mixed. The objective of this secondary analysis is therefore to clarify which institutional constraints and patient demographics bias provider prescribing of opioid analgesics. Methods We used electronic medical record data from an emergency department of a large U.S hospital during years 2008–2014. We ran multi-level logistic regression models to estimate factors associated with providing an opioid prescription during a given visit while controlling for ICD-9 diagnosis codes and between-patient heterogeneity. Results A total of 180,829 patient visits for 63,513 unique patients were recorded during the period of analysis. Overall, providers were significantly less likely to prescribe opioids to the same individual patient when the visit occurred during higher rates of emergency department crowding, later times of day, earlier in the week, later years in our sample, and when the patient had received fewer previous opioid prescriptions. Across all patients, providers were significantly more likely to prescribe opioids to patients who were middle-aged, white, and married. We found no bias towards women and no interaction effects between race and crowding or between race and sex. Conclusions Providers tend to prescribe fewer opioids during constrained diagnostic situations and undertreat pain for patients from high-risk and marginalized demographic groups. Potential harms resulting from previous treatment decisions may accumulate by informing future treatment decisions.

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Association of Primary Care Clinic Appointment Time With Opioid Prescribing

Cited by 55 publications

References 25 publications

Patient mortality after surgery on the surgeon’s birthday: observational study

Patient mortality after surgery on the surgeon’s birthday: observational study

Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand

Provider Bias in prescribing opioid analgesics: a study of electronic medical Records at a Hospital Emergency Department

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