From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine; the Section of Plastic Surgery, Department of Surgery, University of Michigan; and the Division of Plastic Surgery, University of Alberta.
Plast Reconstr Surg. 2019 Jul;144(1):126e-136e. doi: 10.1097/PRS.0000000000005780.
Overprescribing following surgery is a known contributor to the opioid epidemic, increasing the risk of opioid abuse and diversion. Trainees are the primary prescribers of these medications at academic institutions, and little is known about the factors that influence their prescribing. The authors hypothesized that differences in health care funding and delivery would lead to disparities in opioid prescribing. Therefore, the authors sought to compare the prescribing practices of plastic surgery trainees in the United States and Canada.
A survey was administered to trainees at a sample of U.S. and Canadian institutions. The survey queried opioid-prescriber education, factors contributing to prescribing practices, and analgesic prescriptions written after eight procedures. Oral morphine equivalents were calculated for each procedure and compared between groups.
One hundred sixty-two trainees completed the survey, yielding a response rate of 32 percent. Opioid-prescriber education was received by 25 percent of U.S. and 53 percent of Canadian trainees (p < 0.0001). Preoperative counseling was performed routinely by only 11 percent of U.S. and 14 percent of Canadian trainees. U.S. trainees prescribed significantly more oral morphine equivalents than Canadians for seven of eight procedures (p < 0.05). Residency training in the United States and junior training level independently predicted higher oral morphine equivalents prescribed (p < 0.05).
U.S. trainees prescribed significantly more opioids than their Canadian counterparts for seven of eight procedures surveyed. Many trainees are missing a valuable opportunity to provide opioid counseling to patients. Standardizing trainee education may represent an opportunity to reduce overprescribing.
手术后过度开药是阿片类药物流行的已知原因之一，增加了阿片类药物滥用和转移的风险。受训者是学术机构这些药物的主要开方者，但他们的处方决策因素知之甚少。作者假设，医疗保健资金和服务的差异将导致阿片类药物处方的差异。因此，作者试图比较美国和加拿大整形外科受训者的处方实践。
对美国和加拿大的一些机构的受训者进行了问卷调查。调查询问了阿片类药物开方者的教育背景、影响处方实践的因素以及八项手术后的镇痛处方。为每项手术计算了口服吗啡当量，并在组间进行比较。
162 名受训者完成了调查，应答率为 32%。25%的美国受训者和 53%的加拿大受训者接受了阿片类药物开方者的教育（p < 0.0001）。只有 11%的美国和 14%的加拿大受训者常规进行术前咨询。美国受训者对八项手术中的七项开具的口服吗啡当量明显多于加拿大受训者（p < 0.05）。在美国接受住院医师培训和初级培训水平独立预测开方更高的口服吗啡当量（p < 0.05）。
美国受训者对八项调查手术中的七项开具的阿片类药物明显多于加拿大同行。许多受训者错过了向患者提供阿片类药物咨询的宝贵机会。标准化的受训者教育可能是减少过度处方的机会。
