Time of Day is Associated with Opioid Prescribing for Low Back Pain in Primary Care

Philpot, Lindsey M.; Khokhar, Bushra; Roellinger, Daniel L.; Ramar, Priya; Ebbert, Jon O.

doi:10.1007/s11606-018-4521-8

Cited by 27 publications

(25 citation statements)

References 4 publications

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“…12 Other studies have found higher rates of inappropriate antibiotic prescribing and opioid prescribing later in the day. 13,14 In each of these studies, behaviors improved slightly after lunch (a short break for most clinicians), as was the case in the current study.…”

Section: Discussionsupporting

confidence: 67%

Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening

et al. 2019

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Key Points Question Are breast and colorectal cancer screening rates associated with the time of day a patient visits the primary care clinician? Findings In this quality improvement study analysis of 33 primary care practices including 19 254 patients eligible for breast cancer screening and 33 468 patients eligible for colorectal cancer screening, both clinician ordering and patient completion of cancer screening tests decreased as the time of day progressed. Meaning Patients with primary care clinic appointment times later in the day were less likely to be ordered for and receive guideline recommended cancer screening.

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Section: Discussionsupporting

confidence: 67%

Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening

et al. 2019

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“…These results reflect the findings of similar studies of prescription decision fatigue. 2,6 The results show that while interventions to combat the opioid epidemic were successful in reducing the overall amount of opioids prescribed, they had minimal impact on the effect of decision fatigue. Additionally, we had hypothesized that by increasing regulation and social pressure to not prescribe opioids in the midst of this epidemic, the cognitively "easier" choice for physicians in 2017 would change to become not prescribe, and thus prescription likelihood would decrease throughout the clinical day.…”

Section: Discussionmentioning

confidence: 97%

A Multi-year Analysis of Decision Fatigue in Opioid Prescribing

et al. 2019

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“…7 Our own group has observed that patients are more likely to receive opioids later in a clinic half-day session compared with earlier appointments. 9 Provider fatigue attributed to cognitive load and function has been proposed to account for these observed behavior changes. 7,9,10 Fatigue in the workplace is associated with professional guideline deviations 19 and high practice volume has been observed to be associated with lower participatory decision-making practice style among providers.…”

Section: Discussionmentioning

confidence: 99%

“…The behavior of clinicians and staff may change as the clinic day progresses. Patient appointments scheduled later in the day have been associated with reduced rates of cancer screening 7 and immunizations 8 , and higher rates of opioid 9 and antibiotic 10 prescribing. However, the impact of these practice variations on patient experience has yet to be explored.…”

Section: Introductionmentioning

confidence: 99%

Variation in Patient Experience Across the Clinic Day: a Multilevel Assessment of Four Primary Care Practices

et al. 2019

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BACKGROUND: Patient satisfaction with healthcare is associated with clinical outcomes, provider satisfaction, and success of healthcare organizations. As the clinic day progresses, provider fatigue, deterioration with communication within the care team, and appointment spillover may decrease patient experience. OBJECTIVE: To understand the relationship between likelihood to recommend a primary care practice and scheduled appointment time across multiple practice settings. DESIGN: Retrospective cohort. PARTICIPANTS: A retrospective cohort was created of all patients seen within four primary care practices between July 1, 2016, and September 30, 2017. MAIN MEASURES: We looked at scheduled appointment time against patient likelihood to recommend a practice as a measure of overall patient experience collected routinely for clinical practice improvement by the Press Ganey Medical Practice Survey®. Adjusted mixed effects logistic regression models were created to understand the relationship between progressing appointment time on patient likelihood to recommend a practice. We constructed locally weighted smoothing (LOESS) curves to understand how reported patient experience varied over the clinic day. RESULTS: We had a response rate of 14.0% (n = 3172), 80.2% of whom indicated they would recommend our practice to others. Appointment time scheduling during the last hour (4:00-4:59 PM) had a 45% lower odds of recommending our practice when compared to the first clinic hour (adjusted OR = 0.55, 95% CI 0.35-0.86) which is similar when controlling for patient-reported wait time (aOR = 0.59, 95% CI 0.37-0.95). LOESS plots demonstrated declining satisfaction with subsequent appointment times compared with the first session hour, with no effect just after the lunch hour break. CONCLUSIONS: In primary care, appointment time of day is associated with patient-reported experience.

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Time of Day is Associated with Opioid Prescribing for Low Back Pain in Primary Care

Cited by 27 publications

References 4 publications

Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening

Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening

A Multi-year Analysis of Decision Fatigue in Opioid Prescribing

Variation in Patient Experience Across the Clinic Day: a Multilevel Assessment of Four Primary Care Practices

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