Providers More Likely to Prescribe Opioids as the Day Progresses or If They're Running Late

As the country tries to not only address the consequences of the opioid epidemic but also gain a better understanding of opioid-prescribing behaviors, a new study is suggesting that the time of an appointment could influence a provider's decision to prescribe an opioid.

Published in JAMA Network Open, the study findings show that providers are more likely to prescribe opioids later in the day. They also found that if a provider was behind schedule, they were more likely to write the prescription.

“These findings support the widespread perception among providers that time pressure to provide a ‘quick fix’ is one reason why opioids are frequently prescribed in the United States,” Hannah Neprash, assistant professor in the School of Public Health at the University of Minnesota, said in a statement. “If similar patterns exist in other clinical scenarios, such as managing challenging chronic illness, this phenomenon could have relevance for public health and quality improvement efforts.”

As the day progressed, there was a 33% relative increase in opioid prescribing among 5603 primary care doctors seeing more than 600,000 opioid-naïve patients complaining of a painful condition in 2017.

Compared with the first and third appointments of the day, providers were more likely to prescribe patients opioids during the nineteenth and twenty-first appointments of the day (5.3% vs 4.0%).

“Although the absolute difference in prescribing rate across the day of 1.3 percentage points is modest, it is similar in magnitude to the 0.9% absolute reduction in monthly incidence of initial opioid prescribing that occurred nationwide from 2012 to 2017, a period when overall opioid prescription volume decreased substantially in the United States,” noted the researchers, adding that the finding suggests a change of this magnitude could have “meaningful relevance for national trends in opioid use.”

According to the researchers, if rates of opioid prescribing during the first 3 appointments had stayed consistent throughout the day, there would have been 4459 fewer prescriptions that year.

Running late also increased the chances of an opioid prescription, with prescriptions increasing from 4.4% for appointments starting on time to 9 minutes late to 5.2% for appointments running at least an hour late. This represented a 17% relative increase in opioid prescriptions.

In contrast, these patterns in increased prescribing were not seen when looking at nonsteroidal anti-inflammatory drug prescriptions or physical therapy referrals.

The findings, according to the researchers, have several implications for understanding provider decision making and quality measurement, including that “even within individual physicians, clinical decision-making can be meaningfully influenced by external factors.”

They added that interventions to better standardize sensitive treatment decisions, including shared decision-making tools, could minimize the impact of these external factors.

Reference

Neprash H, Barnett M. Association of primary care clinic appointment time with opioid prescribing [published online August 30, 2019]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2019.10373.