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How do physicians adopt and apply opioid prescription guidelines in the emergency department? A qualitative study.

Abstract：

STUDY OBJECTIVE:An increase in prescriptions for opioid pain medications has coincided with increasing opioid overdose deaths. Guidelines designed to optimize opioid prescriptions written in the emergency department have been implemented, with substantial controversy. Little is known about how physicians perceive and apply these guidelines. We seek to identify key themes about emergency physicians' definition, awareness, use, and opinions of opioid-prescribing guidelines. METHODS:We conducted semistructured qualitative interviews with a convenience sample of 61 emergency physicians attending the American College of Emergency Physicians Scientific Assembly (October 2012, Denver, CO). Participants varied with respect to age, sex, geographic region, practice setting, and years of practice experience. We analyzed the interview content with modified grounded theory, an iterative coding process to identify patterns of responses and derive key themes. The study team examined discrepancies in the coding process to ensure reliability and establish consensus. RESULTS:When aware of opioid-prescribing guidelines, emergency physicians often defined them as policies developed by individual hospitals that sometimes reflected guidelines at the state or national level. Guidelines were primarily used by physicians to communicate decisions to limit prescriptions to patients on discharge rather than as tools for decisionmaking. Attitudes toward guidelines varied with regard to general attitudes toward opioid medications, as well as the perceived effects of guidelines on physician autonomy, public health, liability, and patient diversion. CONCLUSION:These exploratory findings suggest that hospital-based opioid guidelines complement and occasionally supersede state and national guidelines and that emergency physicians apply guidelines primarily as communication tools. The perspectives of providers should inform future policy actions that seek to address the problem of opioid abuse and overdose through practice guidelines.

journal_name

Ann Emerg Med

journal_title

Annals of emergency medicine

authors

Kilaru AS,Gadsden SM,Perrone J,Paciotti B,Barg FK,Meisel ZF

doi

10.1016/j.annemergmed.2014.03.015

subject

Has Abstract

pub_date

2014-11-01 00:00:00

pages

482-489.e1

issue

eissn

0196-0644

issn

1097-6760

pii

S0196-0644(14)00221-2

journal_volume

pub_type

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How do physicians adopt and apply opioid prescription guidelines in the emergency department? A qualitative study.