Department of Plastic Surgery, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 6B, Pittsburgh, PA, 15261, USA.
Division of Plastic Surgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Aesthetic Plast Surg. 2020 Apr;44(2):595-603. doi: 10.1007/s00266-019-01588-y. Epub 2020 Jan 6.
The rates of opioid abuse and overdose in America have risen in parallel with the rates of opioid prescribing by physicians. As such, we sought to examine the prescribing practices among plastic surgery attendings and trainees to determine the need for more thorough education.
A survey was distributed to all ACGME-accredited plastic surgery residency programs and included questions regarding opioid-prescribing practices and self-rated ability pertaining to opioid management. Trends in prescribing practices based on prescriber position were analyzed using cumulative odds ordinal logistic regression with proportional odds and Chi-squared tests for ordinal and nominal variables, respectively.
We received 78 responses with a wide geographical representation from plastic surgery residency programs: 59% of respondents were male and 39.7% female, 29.5% were attendings, 26.9% senior residents, 29.5% junior residents, and 14.1% interns. Compared with attendings, interns prescribe fewer pills (p < 0.05) and were significantly more likely to prescribe oxycodone (p < 0.03). Junior residents were 4.49 times more likely (p = 0.012) and senior residents 3.65 times more likely (p = 0.029) to prescribe additional opioids to avoid phone calls and follow-up visits. Interns and senior residents were significantly less comfortable than attendings in managing patients requesting additional opioids (p < 0.02).
The results of this survey demonstrate that knowledge deficits do exist among trainees, and that trainees are significantly less comfortable than their attending counterparts with opioid prescribing and patient management. Therefore, the implementation of a thorough postoperative pain management education in residency may be a cogent strategy in mitigating the opioid crisis.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
在美国，阿片类药物滥用和过量的发生率与医生开具阿片类药物的比例平行上升。因此，我们试图研究整形外科主治医生和住院医师的处方实践，以确定是否需要更全面的教育。
我们向所有 ACGME 认证的整形外科住院医师培训计划分发了一份调查，其中包括关于阿片类药物处方实践和自我评估的阿片类药物管理能力的问题。基于处方者职位的处方实践趋势分析采用累积优势有序逻辑回归，分别使用比例优势和卡方检验进行有序和名义变量分析。
我们收到了来自整形外科住院医师培训计划的 78 份回复，回复者来自广泛的地理区域：59%的回复者为男性，39.7%为女性，29.5%为主治医生，26.9%为高级住院医师，29.5%为初级住院医师，14.1%为实习生。与主治医生相比，实习生开具的药丸更少（p<0.05），并且更有可能开具羟考酮（p<0.03）。初级住院医师开具额外阿片类药物以避免电话和随访的可能性是主治医生的 4.49 倍（p=0.012），高级住院医师开具额外阿片类药物的可能性是主治医生的 3.65 倍（p=0.029）。实习生和高级住院医师在管理要求额外阿片类药物的患者方面明显不如主治医生舒适（p<0.02）。
这项调查的结果表明，受训者确实存在知识缺陷，并且受训者在开具阿片类药物和管理患者方面明显不如主治医生舒适。因此，在住院医师培训中实施全面的术后疼痛管理教育可能是减轻阿片类药物危机的一项有力策略。
证据水平 III：本杂志要求作者为每篇文章指定一个证据水平。有关这些循证医学评级的完整描述，请参考目录或在线作者指南 www.springer.com/00266。
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