%0 Randomized Controlled Trial
%T Peer Comparison or Guideline-Based Feedback and Postsurgery Opioid Prescriptions: A Randomized Clinical Trial.
%A Wagner Z
%A Kirkegaard A
%A Mariano LT
%A Doctor JN
%A Yan X
%A Persell SD
%A Goldstein NJ
%A Fox CR
%A Brummett CM
%A Romanelli RJ
%A Bouskill K
%A Martinez M
%A Zanocco K
%A Meeker D
%A Mudiganti S
%A Waljee J
%A Watkins KE
%J JAMA Health Forum
%V 5
%N 3
%D 2024 Mar 1
%M 38488780
暂无%R 10.1001/jamahealthforum.2024.0077
%X UNASSIGNED: Excess opioid prescribing after surgery can result in prolonged use and diversion. Email feedback based on social norms may reduce the number of pills prescribed.
UNASSIGNED: To assess the effectiveness of 2 social norm-based interventions on reducing guideline-discordant opioid prescribing after surgery.
UNASSIGNED: This cluster randomized clinical trial conducted at a large health care delivery system in northern California between October 2021 and October 2022 included general, obstetric/gynecologic, and orthopedic surgeons with patients aged 18 years or older discharged to home with an oral opioid prescription.
UNASSIGNED: In 19 hospitals, 3 surgical specialties (general, orthopedic, and obstetric/gynecologic) were randomly assigned to a control group or 1 of 2 interventions. The guidelines intervention provided email feedback to surgeons on opioid prescribing relative to institutionally endorsed guidelines; the peer comparison intervention provided email feedback on opioid prescribing relative to that of peer surgeons. Emails were sent to surgeons with at least 2 guideline-discordant prescriptions in the previous month. The control group had no intervention.
UNASSIGNED: The probability that a discharged patient was prescribed a quantity of opioids above the guideline for the respective procedure during the 12 intervention months.
UNASSIGNED: There were 38 235 patients discharged from 640 surgeons during the 12-month intervention period. Control-group surgeons prescribed above guidelines 36.8% of the time during the intervention period compared with 27.5% and 25.4% among surgeons in the peer comparison and guidelines arms, respectively. In adjusted models, the peer comparison intervention reduced guideline-discordant prescribing by 5.8 percentage points (95% CI, -10.5 to -1.1; P = .03) and the guidelines intervention reduced it by 4.7 percentage points (95% CI, -9.4 to -0.1; P = .05). Effects were driven by surgeons who performed more surgeries and had more guideline-discordant prescribing at baseline. There was no significant difference between interventions.
UNASSIGNED: In this cluster randomized clinical trial, email feedback based on either guidelines or peer comparison reduced opioid prescribing after surgery. Guideline-based feedback was as effective as peer comparison-based feedback. These interventions are simple, low-cost, and scalable, and may reduce downstream opioid misuse.
UNASSIGNED: ClinicalTrials.gov NCT05070338.