Bhashyam Abhiram R, Young Jason, Qudsi Rameez A, Parisien Robert L, Dyer George S M
Department of Orthopaedic Surgery, Harvard Combined Orthopaedics Residency Program, Boston, MA.
Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA.
J Hand Surg Am. 2019 Mar;44(3):201-207.e2. doi: 10.1016/j.jhsa.2018.11.003. Epub 2019 Jan 8.
In many academic medical centers, resident physicians typically write initial opioid prescriptions, but little is known about their prescribing practices. We hypothesized that lower resident postgraduate year, residency-training program, and noncompletion of an opioid prescribing training would be factors associated with increased opioid prescribing by orthopedic residents after open reduction and internal fixation of distal radius fractures.
A survey was administered to all 135 residents from 4 orthopedic residency programs in a state located in the northeastern United States between August 2017 and November 2017. Respondents were asked to indicate the initial analgesia (quantity and duration) they would prescribe for a younger and older, otherwise healthy, opiate-naïve female patient after open reduction and internal fixation of a distal radius fracture. We analyzed the quantity of initial opioids prescribed in morphine milligram equivalents (MME) and number of days supplied. Three different measures of overprescribing were assessed: prescribing over 150 MME, 225 MME, or 7 days of opioids.
The response rate was 63% (85 of 135 residents). Of all respondents, 36.5% of residents reported completion of an opioid training in the past. In terms of overprescribing by duration, 19% of residents prescribed more than 7 days of opioids. For overprescribing by quantity, 36% to 59% (depending on patient age) of residents prescribed more than 20 tablets of 5 mg oxycodone (150 MME) and 16% to 25% (depending on patient age) prescribed more than 30 tablets of 5 mg oxycodone (225 MME). In comparison with junior residents, senior residents were more likely to prescribe over 225 MME.
After open reduction and internal fixation of distal radius fractures, 19% of orthopedic surgery residents would prescribe more than 7 days of prescription opioids, which is beyond the state law maximum. In addition, we found that less than half of residents had participated in an opioid training program. Our results highlight the need for continued resident guidance when prescribing. Enrollment in opioid prescribing training programs that have been shown to decrease prescribed opioid quantities while still effectively managing patient pain is probably important.
This study describes the opioid prescribing practices and prior training of orthopedic residents. It highlights an opportunity for increased involvement in educational programs on opioid prescribing that better align with published recommendations/guidelines.
在许多学术性医学中心，住院医师通常会开具初始阿片类药物处方，但对他们的处方行为知之甚少。我们推测，较低的住院医师研究生年级、住院医师培训项目以及未完成阿片类药物处方培训，可能是与骨科住院医师在桡骨远端骨折切开复位内固定术后增加阿片类药物处方相关的因素。
2017年8月至2017年11月期间，对美国东北部一个州4个骨科住院医师培训项目的135名住院医师进行了一项调查。受访者被要求指出，对于一名年轻和一名年长的、其他方面健康且未使用过阿片类药物的女性患者，在桡骨远端骨折切开复位内固定术后，他们会开具的初始镇痛药物（数量和持续时间）。我们分析了以吗啡毫克当量（MME）表示的初始阿片类药物处方量以及提供的天数。评估了三种不同的过量处方衡量标准：开具超过150 MME、225 MME或7天的阿片类药物。
回复率为63%（135名住院医师中的85名）。在所有受访者中，36.5%的住院医师报告过去完成了阿片类药物培训。就按持续时间的过量处方而言，19%的住院医师开具了超过7天的阿片类药物。就按数量的过量处方而言，36%至59%（取决于患者年龄）的住院医师开具了超过20片5毫克羟考酮（150 MME），16%至25%（取决于患者年龄）的住院医师开具了超过30片5毫克羟考酮（225 MME）。与初级住院医师相比，高级住院医师更有可能开具超过225 MME的药物。
在桡骨远端骨折切开复位内固定术后，19%的骨外科住院医师会开具超过7天的处方阿片类药物，这超出了该州法律的上限。此外，我们发现不到一半的住院医师参加过阿片类药物培训项目。我们的结果凸显了在开处方时持续对住院医师进行指导的必要性。参加已被证明能减少阿片类药物处方量同时仍有效管理患者疼痛的阿片类药物处方培训项目可能很重要。
本研究描述了骨科住院医师的阿片类药物处方行为及先前培训情况。它凸显了一个增加参与与已发表的建议/指南更相符的阿片类药物处方教育项目的机会。
