评估外科住院医师和教员的阿片类药物处方偏好。
Evaluation of opioid prescribing preferences among surgical residents and faculty.
机构信息
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO. Electronic address: https://twitter.com/THuynhMD.
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO. Electronic address: https://twitter.com/ColbornKathryn.
出版信息
Surgery. 2021 Oct;170(4):1066-1073. doi: 10.1016/j.surg.2021.02.067. Epub 2021 Apr 12.
BACKGROUND
Residents report that faculty preference is a significant driver of opioid prescribing practices. This study compared opioid prescribing preferences of surgical residents and faculty against published guidelines and actual practice and assessed perceptions in communication and transparency around these practices.
METHODS
Surgical residents and faculty were surveyed to evaluate the number of oxycodone tablets prescribed for common procedures. Quantities were compared between residents, faculty, Opioid Prescribing Engagement Network guidelines, and actual opioids prescribed. Frequency with which faculty communicate prescribing preferences and the desire for feedback and transparency in prescription practices were assessed.
RESULTS
Fifty-six (72%) residents and 57 (59%) faculty completed the survey. Overall, faculty preferred a median number of tablets greater than recommended by Opioid Prescribing Engagement Network in 5 procedures, while residents did so in 9 of 14 procedures. On average, across all operations, faculty reported prescribing practices compliant with Opioid Prescribing Engagement Network 56.1% of the time, whereas residents did so 47.6% of the time (P = .40). Interestingly, opioids actually prescribed were significantly less than recommended in 7 procedures. Among faculty, 62% reported often or always specifying prescription preferences to residents, while only 9% of residents noted that faculty often did so. Residents (80%) and faculty (75%) were amenable to seeing regular reports of personal opioid prescription practices, and 74% and 65% were amenable to seeing practices compared with peers. Only 34% of residents and 44% of faculty wanted prescription practices made public.
CONCLUSION
There is a disconnect between opioid prescribing preferences and practice among surgical residents and faculty. Increased transparency through individualized reports and education regarding Opioid Prescribing Engagement Network guidelines with incorporation into the electronic medical record as practice advisories may reduce prescription variability.
背景
住院医师报告称，教师偏好是影响阿片类药物处方实践的重要因素。本研究比较了外科住院医师和教师的阿片类药物处方偏好与已发表的指南和实际实践，并评估了这些实践在沟通和透明度方面的看法。
方法
对外科住院医师和教师进行了调查，以评估常见手术中开处的羟考酮片数量。将居民、教师、阿片类药物处方参与网络指南和实际开处的阿片类药物数量进行了比较。评估了教师沟通处方偏好的频率以及对处方实践反馈和透明度的需求。
结果
56 名（72%）住院医师和 57 名（59%）教师完成了调查。总体而言，在 5 项手术中，教师偏爱比阿片类药物处方参与网络指南推荐的中位数更多的片剂，而住院医师在 14 项手术中的 9 项中偏爱如此。平均而言，在所有手术中，教师报告遵守阿片类药物处方参与网络指南的处方实践时间为 56.1%，而住院医师为 47.6%（P=0.40）。有趣的是，在 7 项手术中实际开处的阿片类药物明显少于推荐剂量。在教师中，62%的人表示经常或总是向住院医师指定处方偏好，而只有 9%的住院医师注意到教师经常这样做。住院医师（80%）和教师（75%）都愿意定期查看个人阿片类药物处方实践报告，74%和 65%的人都愿意将自己的实践与同行进行比较。只有 34%的住院医师和 44%的教师希望公开处方实践。
结论
外科住院医师和教师的阿片类药物处方偏好与实践之间存在脱节。通过个性化报告和关于阿片类药物处方参与网络指南的教育增加透明度，并将其纳入电子病历作为实践建议，可能会减少处方的变异性。
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