65% of Docs Prescribed More Opioids Than They Thought

Few healthcare providers, if any, consider themselves among the heaviest prescribers of opioids. But the reality is, the top tier includes some clinicians, whether they believe it or not.

In fact, the results of a new study suggest that 65% of emergency department providers underestimate the number of opioid prescriptions they write. Their self-perception was “frequently inaccurate,” wrote the research team, which consisted of investigators from the University of Colorado’s Anschutz Medical Campus and the University of Massachusetts Medical School. However, the providers’ prescribing habits decreased after they received data on how often they doled out opioids, the type of painkiller that has caused a nationwide crisis in recent years.

“Everyone showed an overall decrease in prescribing opioids,” said study author Sean Michael, MD, MBA, an assistant professor of emergency medicine at the University of Colorado School of Medicine.

Over the course of the yearlong study, researchers surveyed 109 emergency medicine clinicians in 4 hospital emergency departments, gauging their estimated opioid prescribing rates compared to their peers, according to the study. The providers discharged nearly 120,000 patients, penning more than 75,000 prescriptions, with opioids accounting for more than 15,000, or 20%, according to the findings.

>>Read our latest cover story, Rise of the Anti-Opioid Algorithm.

Then, 51 of the clinicians were randomly selected to undergo an intervention in which they were told their true prescribing rates and those of their colleagues. Six months after participants with inaccurate self-perceptions saw their actual data, they wrote 2.1 fewer opioid prescriptions per 100 patients and 2.2 fewer following 1 year, Michael noted.

“Thus an intervention to identify and unmask inaccurate self-perception—and correct that perception using a provider’s actual data—appears to have enabled more robust behavior change for a subset of providers who may have otherwise had difficulty internalizing the need to change,” the researchers noted. “Our findings suggest that guideline and policy interventions should directly address the potential barrier of inaccurate provider self‐awareness.”

The disconnect between physicians and their perceived prescribing habits isn’t shocking to everyone. Experts working for various kinds of healthcare companies, like insurers, told Healthcare Analytics News™ that they have performed similar audits, to the unfortunate surprise of top-prescribing docs. In 1 case, the physicians became angry but relented upon reviewing the data.

This study also gets at a larger issue clouding the intersection of medicine and technology: cultural resistance. Clinicians have been notoriously skeptical of some high-tech tools, but anecdotes from healthcare leaders have repeatedly suggested that data are the sledgehammer that can break down that wall.

Emergency department physicians write only 5 to 10% of the country’s opioid prescriptions, a number that indicates the self-awareness problem is more widespread, Michael said.

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