{Reference Type}: Randomized Controlled Trial
{Title}: Peer Comparison or Guideline-Based Feedback and Postsurgery Opioid Prescriptions: A Randomized Clinical Trial.
{Author}: Wagner Z;Kirkegaard A;Mariano LT;Doctor JN;Yan X;Persell SD;Goldstein NJ;Fox CR;Brummett CM;Romanelli RJ;Bouskill K;Martinez M;Zanocco K;Meeker D;Mudiganti S;Waljee J;Watkins KE;
{Journal}: JAMA Health Forum
{Volume}: 5
{Issue}: 3
{Year}: 2024 Mar 1
暂无{DOI}: 10.1001/jamahealthforum.2024.0077
{Abstract}: <B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>To assess the effectiveness of 2 social norm-based interventions on reducing guideline-discordant opioid prescribing after surgery.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>The probability that a discharged patient was prescribed a quantity of opioids above the guideline for the respective procedure during the 12 intervention months.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>ClinicalTrials.gov NCT05070338.