PDF(Pubmed)
Abstract：
BACKGROUND: Excess opioid prescribing after surgery can lead to prolonged opioid use and diversion. We interviewed surgeons who were part of a three-group cluster-randomised controlled trial aimed at reducing prescribed opioid quantities after surgery via two versions of a monthly emailed behavioural \'nudge\' (messages encouraging but not mandating compliance with social norms and clinical guidelines around prescribing) at the end of the implementation year in order to understand surgeons\' reasoning for changing or continuing their prescribing behaviour as a result of the intervention and the context for their rationale.
METHODS: The study took place at a large healthcare system in northern California with surgeons from three surgical specialties-orthopaedics, obstetrics/gynaecology and general surgery. Following the intervention period, we conducted semistructured interviews with 36 surgeons who had participated in the trial, ensuring representation across trial arm, specialty and changes in prescribing quantities over the year. Interviews focused on reactions to the nudges, impacts of the nudges on prescribing behaviours and other factors impacting prescribing. Three study team members coded and analysed the transcribed interviews.
RESULTS: Nudges were equally effective in reducing postsurgical opioid prescribing across surgical specialties and between intervention arms. Surgeons were generally receptive to the nudge intervention, noting that it reduced the size of their discharge opioid prescriptions by improving their awareness and intentionality around prescribing. Most were unaware that clinical guidelines around opioid prescribing existed. Some had reservations regarding the accuracy and context of information provided in the nudges, the prescription quantities encouraged by the nudges and feelings of being watched or admonished. A few described discussing the nudges with colleagues. Respondents emphasised that the prescribing behaviours are informed by individual clinical experience and patient-related and procedure-related factors.
CONCLUSIONS: Surgeons were open to learning about their prescribing behaviour through comparisons to guidelines or peer behaviour and incorporating this feedback as one of several factors that guide discharge opioid prescribing. Increasing awareness of clinical guidelines around opioid prescribing is important for curbing postsurgical opioid overprescribing.
BACKGROUND: NCT05070338.
METHODS: The study took place at a large healthcare system in northern California with surgeons from three surgical specialties-orthopaedics, obstetrics/gynaecology and general surgery. Following the intervention period, we conducted semistructured interviews with 36 surgeons who had participated in the trial, ensuring representation across trial arm, specialty and changes in prescribing quantities over the year. Interviews focused on reactions to the nudges, impacts of the nudges on prescribing behaviours and other factors impacting prescribing. Three study team members coded and analysed the transcribed interviews.
RESULTS: Nudges were equally effective in reducing postsurgical opioid prescribing across surgical specialties and between intervention arms. Surgeons were generally receptive to the nudge intervention, noting that it reduced the size of their discharge opioid prescriptions by improving their awareness and intentionality around prescribing. Most were unaware that clinical guidelines around opioid prescribing existed. Some had reservations regarding the accuracy and context of information provided in the nudges, the prescription quantities encouraged by the nudges and feelings of being watched or admonished. A few described discussing the nudges with colleagues. Respondents emphasised that the prescribing behaviours are informed by individual clinical experience and patient-related and procedure-related factors.
CONCLUSIONS: Surgeons were open to learning about their prescribing behaviour through comparisons to guidelines or peer behaviour and incorporating this feedback as one of several factors that guide discharge opioid prescribing. Increasing awareness of clinical guidelines around opioid prescribing is important for curbing postsurgical opioid overprescribing.
BACKGROUND: NCT05070338.
摘要：
背景：手术后过量的阿片类药物处方会导致阿片类药物长期使用和转移。我们采访了作为一项三组随机对照试验的一部分的外科医生，该试验旨在通过两个版本的每月电子邮件行为\'nudge\'（鼓励但不要求遵守社会规范和临床指南有关处方的信息）来减少手术后处方阿片类药物的数量在实施年度结束时，以了解外科医生因干预而改变或继续其处方行为的理由及其背景。
方法：这项研究是在加利福尼亚州北部的一个大型医疗系统中进行的，来自三个外科专业的外科医生-骨科，妇产科和普外科。干预期之后,我们对参与试验的36名外科医生进行了半结构化访谈，确保跨审判臂的代表性，专业和一年来处方数量的变化。面试的重点是对轻推的反应，轻推对处方行为的影响以及影响处方的其他因素。三名研究小组成员对转录的访谈进行了编码和分析。
结果：Nudges在减少手术专业和干预组之间的术后阿片类药物处方方面同样有效。外科医生通常接受轻推干预，注意到，它通过提高他们对处方的认识和意图，减少了他们出院阿片类药物处方的规模。大多数人不知道存在阿片类药物处方的临床指南。一些人对轻推中提供的信息的准确性和背景持保留态度，受轻推和被监视或告诫的感觉所鼓励的处方数量。一些人描述了与同事讨论轻推。受访者强调，处方行为是由个人临床经验以及患者相关和程序相关因素决定的。
结论：外科医生愿意通过与指南或同伴行为的比较来了解他们的处方行为，并将这种反馈作为指导阿片类药物处方的几个因素之一。提高对阿片类药物处方的临床指南的认识对于遏制术后阿片类药物处方过量很重要。
背景：NCT05070338。
方法：这项研究是在加利福尼亚州北部的一个大型医疗系统中进行的，来自三个外科专业的外科医生-骨科，妇产科和普外科。干预期之后,我们对参与试验的36名外科医生进行了半结构化访谈，确保跨审判臂的代表性，专业和一年来处方数量的变化。面试的重点是对轻推的反应，轻推对处方行为的影响以及影响处方的其他因素。三名研究小组成员对转录的访谈进行了编码和分析。
结果：Nudges在减少手术专业和干预组之间的术后阿片类药物处方方面同样有效。外科医生通常接受轻推干预，注意到，它通过提高他们对处方的认识和意图，减少了他们出院阿片类药物处方的规模。大多数人不知道存在阿片类药物处方的临床指南。一些人对轻推中提供的信息的准确性和背景持保留态度，受轻推和被监视或告诫的感觉所鼓励的处方数量。一些人描述了与同事讨论轻推。受访者强调，处方行为是由个人临床经验以及患者相关和程序相关因素决定的。
结论：外科医生愿意通过与指南或同伴行为的比较来了解他们的处方行为，并将这种反馈作为指导阿片类药物处方的几个因素之一。提高对阿片类药物处方的临床指南的认识对于遏制术后阿片类药物处方过量很重要。
背景：NCT05070338。
