Surgeons’ Perspectives on Changing the Default Number of Doses for Opioid Prescriptions in Electronic Health Record Systems

Abstract

ImportanceAn intervention in 2021 at a tertiary medical center found that the implementation of evidence-based default dosing settings for opioid prescriptions written in electronic health record systems was associated with reduced opioid prescribing to adolescents and young adults aged 12 to 25 years undergoing tonsillectomy. It is unclear whether surgeons were aware of this intervention, whether they thought the intervention was acceptable, or whether they believed similar interventions were feasible to implement in other surgical populations and institutions.ObjectiveTo assess surgeons’ experiences and perspectives regarding an intervention that changed the default number of doses for opioid prescriptions to an evidence-based level.Design, Setting, and ParticipantsThis qualitative study was conducted at a tertiary medical center during October 2021, 1 year after implementation of the intervention, in which the default number of doses for opioid prescriptions written through an electronic health record system to adolescents and young adults undergoing tonsillectomy was lowered to an evidence-based level. Semistructured interviews were conducted with otolaryngology attending and resident physicians who had cared for the adolescents and young adults undergoing tonsillectomy after implementation of the intervention. Factors that play a role in opioid prescribing decisions after surgery and participants’ awareness of and views on the intervention were assessed. The interviews were coded inductively and a thematic analysis was performed. Analyses were conducted from March to December 2022.ExposureChange in the default dosing settings for opioid prescriptions written in an electronic health record system to adolescents and young adults undergoing tonsillectomy.Main Outcomes and MeasuresSurgeons’ experiences and perspectives regarding the intervention.ResultsThe 16 otolaryngologists interviewed included 11 residents (68.8%), 5 attending physicians (31.2%), and 8 women (50.0%). No participant reported noticing the change in the default settings, including those who wrote opioid prescriptions with the new default number of opioid doses. From the interviews, 4 themes regarding surgeons' perceptions and experiences of the intervention emerged: (1) opioid prescribing decisions are influenced by patient, procedure, physician, and health system factors; (2) defaults may substantially influence prescribing behavior; (3) support for the default dosing setting intervention depended on whether it was evidence-based and had unintended consequences; and (4) changing the default dosing settings is potentially feasible in other surgical populations and institutions.Conclusions and RelevanceThese findings suggest that interventions to change the default dosing settings for opioid prescriptions may be feasible to implement in a variety of surgical populations, particularly if the new settings are evidence-based and if unintended consequences are carefully monitored.

Surgeons’ views of peer comparison and guideline-based feedback on postsurgery opioid prescriptions: a qualitative investigation

“…However, surgeons still need to understand the evidence base for the guidelines and ideally be involved in the development of the intervention. 11 …”

“…To our knowledge, only three studies on postsurgical discharge opioid prescribing interventions have explored surgeons’ reactions, finding that surgeons were generally supportive of the interventions but had concerns about adequate pain management and the interventions’ appropriateness. 11–13 …”