Brooks Bradley M, Shih Chia-Ding, Bratches Reed W R, Arp Allison S, Coughlin Gerard J, Wolff Kristina B, Brooks Brandon M
*University of South Alabama Health, Mobile, AL.
†California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA.
J Am Podiatr Med Assoc. 2023 May-Jun;113(3). doi: 10.7547/21-215.
Given that excess opioid prescriptions contribute to the US opioid epidemic and there are few national opioid-prescribing guidelines for the management of acute pain, it is pertinent to determine whether prescribers can sufficiently assess their own prescribing practice. We investigated podiatric surgeons' ability to evaluate whether their own opioid-prescribing practice is less than, near, or above that of an "average" prescriber.
We administered a scenario-based, voluntary, anonymous, online questionnaire consisting of five surgery-based scenarios commonly performed by podiatric surgeons. Respondents were asked the quantity of opioids they would prescribe at the time of surgery. Respondents were also asked to rate their prescribing practice compared with the average (median) podiatric surgeon. We compared self-reported behavior to self-reported perception ("I prescribe less than average," "I prescribed about average," and "I prescribe more than average"). Analysis of variance was used for univariate analysis among the three groups. We used linear regression to adjust for confounders. Data restriction was used to account for restrictive state laws.
One hundred fifteen podiatric surgeons completed the survey in April 2020. Less than half of the time, respondents accurately identified their own category. Consequently, there were no statistically significant differences among podiatric surgeons who reported that they "prescribe less," "prescribe about average," and "prescribe more." Paradoxically, there was a flip in scenario 5: respondents who reported they "prescribe more" actually prescribed the least and respondents who believed they "prescribe less" actually prescribed the most.
Cognitive bias, in the form of a novel effect, occurs in postoperative opioid-prescribing practice; in the absence of procedure-specific guidelines or an objective standard, podiatric surgeons, more often than not, were unaware of how their own opioid-prescribing practice measured up to that of other podiatric surgeons.
鉴于过量的阿片类药物处方导致了美国的阿片类药物流行，且几乎没有用于急性疼痛管理的全国性阿片类药物处方指南，确定开处方者是否能够充分评估自己的处方行为就显得至关重要。我们调查了足病外科医生评估自己的阿片类药物处方行为低于、接近或高于“平均”开处方者的能力。
我们发放了一份基于情景的、自愿的、匿名的在线问卷，其中包含足病外科医生通常进行的五种手术情景。询问受访者在手术时会开出的阿片类药物数量。还要求受访者将自己的处方行为与平均（中位数）足病外科医生进行比较。我们将自我报告的行为与自我报告的认知（“我的处方量低于平均水平”、“我的处方量约为平均水平”和“我的处方量高于平均水平”）进行了比较。方差分析用于三组之间的单变量分析。我们使用线性回归来调整混杂因素。数据限制用于考虑限制性州法律。
115名足病外科医生于2020年4月完成了调查。不到一半的情况下，受访者准确识别了自己的类别。因此，报告“处方量较少”、“处方量约为平均水平”和“处方量较多”的足病外科医生之间没有统计学上的显著差异。矛盾的是，在情景5中出现了反转：报告“处方量较多”的受访者实际开药量最少，而认为自己“处方量较少”的受访者实际开药量最多。
以一种新效应形式出现的认知偏差发生在术后阿片类药物处方行为中；在缺乏特定手术指南或客观标准的情况下，足病外科医生往往不知道自己的阿片类药物处方行为与其他足病外科医生相比如何。
