Department of Medicine, University of Washington School of Medicine, Seattle, WA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Am J Med Qual. 2023;38(3):129-136. doi: 10.1097/JMQ.0000000000000117. Epub 2023 Apr 5.
Peer comparison feedback is a promising strategy for reducing opioid prescribing and opioid-related harms. Such comparisons may be particularly impactful among underestimating clinicians who do not perceive themselves as high prescribers relative to their peers. But peer comparisons could also unintentionally increase prescribing among overestimating clinicians who do not perceive themselves as lower prescribers than peers. The objective of this study was to assess if the impact of peer comparisons varied by clinicians' preexisting opioid prescribing self-perceptions. Subgroup analysis of a randomized trial of peer comparison interventions among emergency department and urgent care clinicians was used. Generalized mixed-effects models were used to assess whether the impact of peer comparisons, alone or combined with individual feedback, varied by underestimating or overestimating prescriber status. Underestimating and overestimating prescribers were defined as those who self-reported relative prescribing amounts that were lower and higher, respectively, than actual relative baseline amounts. The primary outcome was pills per opioid prescription. Among 438 clinicians, 54% (n = 236) provided baseline prescribing self-perceptions and were included in this analysis. Overall, 17% (n = 40) were underestimating prescribers whereas 5% (n = 11) were overestimating prescribers. Underestimating prescribers exhibited a differentially greater decrease in pills per prescription compared to nonunderestimating clinicians when receiving peer comparison feedback (1.7 pills, 95% CI, -3.2 to -0.2 pills) or combined peer and individual feedback (2.8 pills, 95% CI, -4.8 to -0.8 pills). In contrast, there were no differential changes in pills per prescription for overestimating versus nonoverestimating prescribers after receiving peer comparison (1.5 pills, 95% CI, -0.9 to 3.9 pills) or combined peer and individual feedback (3.0 pills, 95% CI, -0.3 to 6.2 pills). Peer comparisons were more impactful among clinicians who underestimated their prescribing compared to peers. By correcting inaccurate self-perceptions, peer comparison feedback can be an effective strategy for influencing opioid prescribing.
同伴比较反馈是减少阿片类药物处方和阿片类相关危害的一种有前途的策略。在那些低估自己的处方量而认为自己不如同行的医生中，这种比较可能尤其有影响力。但是，同伴比较也可能会在那些高估自己的处方量而认为自己的处方量低于同行的医生中无意中增加处方量。本研究的目的是评估同伴比较的影响是否因临床医生预先存在的阿片类药物处方自我认知而有所不同。使用了一项针对急诊室和紧急护理临床医生的同伴比较干预随机试验的亚组分析。使用广义混合效应模型来评估同伴比较（单独或与个人反馈结合使用）的影响是否因低估或高估处方地位而有所不同。低估和高估的处方者定义为自我报告的相对处方量分别低于和高于实际的相对基线量。主要结果是每阿片类药物处方的药丸数。在 438 名临床医生中，有 54%（n=236）提供了基线处方自我认知，并纳入了本分析。总体而言，17%（n=40）为低估处方者，而 5%（n=11）为高估处方者。与非低估临床医生相比，接受同伴比较反馈（1.7 片，95%CI，-3.2 至-0.2 片）或联合同伴和个人反馈（2.8 片，95%CI，-4.8 至-0.8 片）时，低估处方者的每处方药丸数差异较大。相比之下，接受同伴比较（1.5 片，95%CI，-0.9 至 3.9 片）或联合同伴和个人反馈（3.0 片，95%CI，-0.3 至 6.2 片）后，高估处方者的每处方药丸数没有差异变化。在低估自己的处方量而认为自己不如同行的医生中，同伴比较更具影响力。通过纠正不准确的自我认知，同伴比较反馈可以成为影响阿片类药物处方的有效策略。
