According to a study, researchers worked on Implementing a default option for a lower quantity of tablets in the electronic medical records (EMR) discharge orders may help combat the issue by "nudging" physicians to prescribe smaller quantities consistent with prescribing guidelines Penn Medicine researchers show in a new study published in the Journal of General Internal Medicine.

The research team found that physicians from two Penn Medicine emergency departments prescribed a fewer number of opioid pills to their patients when the EMR default setting was set to 10 tablets. Initial prescriptions for that amount shot up by 22 percent, from a pre-default rate of 21 percent to 43 percent after the default option had been introduced.

Conversely, the number of prescriptions written for 20 tablets decreased by almost 7 percent, and prescriptions for 11 to 19 tablets decreased by over 13 percent. M. Kit Delgado said, "Our results represent a promising and much-needed scalable approach that could successfully nudge physicians managing acute pain to prescribe smaller doses of opioid medications for those who need them."

"We know that prescribing too many opioid tablets for acute pain increases a patient's risk for long-term use or the potential to be abused if left in the medicine cabinet, so making it easier to prescribe quantities consistent with current guidelines while still keeping physician autonomy is an important part of addressing the opioid crisis we're facing in this country."

The researchers compared weekly prescribing patterns for oxycodone 5mg/acetaminophen (325 mg) for 41 weeks. In all, physicians wrote over 3,200 prescriptions. After the default implementation, the median number of opioid tablets supplied per prescription decreased by a small amount from an already low baseline of 11.3 to 10 at HUP and 12.6 to 10.9 at PPMC.

However, across the two emergency departments there was a marked increase in the proportion of prescriptions written for 10 tablets, from 20.6 percent to 43.3 percent, whereas prescriptions for larger quantities dropped. With implementation of the default of 10 tablets, there was a small unintended decrease in prescriptions written for less than 10 tablets.

"This suggests that future efforts to set default quantities should provide a default option for the lowest baseline prescription," the authors wrote. Many studies have shown how default options can positively influence physician behavior and prescriptions. Last year, Penn researchers found that a change to default options increased generic drug prescribing rates from 75 percent to 98 percent.

Author concludes that a three-year project will not only study the default option for opioids in emergency rooms, but monthly reports comparing each physician's prescribing patterns will also be shared with peers to see if that may nudge them to prescribe smaller amounts.