Asking emergency department (ED) providers to self-identify their opioid prescribing practices and then providing them with clinically relevant, and actionable feedback on their actual opioid prescribing data decreases future opioid prescribing.

That is the finding of a study to be published in the May 2018 issue of Academic Emergency Medicine (AEM), a journal of the Society for Academic Emergency Medicine (SAEM). The lead author of the study is Sean S. Michael, MD, assistant professor of emergency medicine at the University of Colorado Denver School of Medicine.

The study, by Michael et al., found that providers who initially underestimated opiate prescription rates had statistically significant decreases in opiate prescribing when compared to providers who were more accurate in initial self-assessment of prescribing rates. 

The randomized trial exposes important gaps in providers' self-perceptions of opioid prescribing and demonstrates that a simple, data-driven intervention using query-reveal methodology may decrease future prescribing, particularly among providers who underestimate their prescribing practices.

This was a prospective, multicenter randomized trial in which all were attending physicians, residents, and advanced practice providers at four EDs were randomly assigned either to no intervention or to a brief data?driven intervention during which providers were: 

1) Asked to self?identify and explicitly report to research staff their perceived opioid prescribing in comparison to their peers.

2) The actual data with peer group norms for comparison were given.

Prospective, multicenter randomized trial 

Among 109 total participants, 51 were randomized to the intervention, 65% of whom underestimated their opioid prescribing. Intervention participants who underestimated their baseline prescribing had larger?magnitude decrease than controls.

Hodges?Lehmann difference were found to be –2.1 prescriptions per hundred patients at 6 months [95% confidence interval {CI} = –3.9 to –0.5] and –2.2 per hundred at 12 months [95% CI = –4.8 to –0.01]). Intervention participants who did not underestimate their prescribing had similar changes to controls.

The findings suggest that current and future interventions in which provider adherence to guidelines is expected, including opioid interventions outside the emergency department and other quality and safety initiatives, should directly address the potential barrier of inaccurate provider self-awareness.

Gail D'Onofrio, MD, MS, professor and chair, Yale School of Medicine Department of Emergency Medicine, who is internationally known for her work in developing and testing interventions for department patients with unhealthy alcohol and other drug use, commented:

"The results have real-world applicability. A simple intervention enhancing safe prescribing is one of several opportunities the emergency physician has to combat the current opioid epidemic," said D'Onofrio.

Self?perception of prescribing was frequently inaccurate. Providing clinicians with their actual opioid prescribing data after querying their self?perception reduced future prescribing among providers who underestimated their baseline prescribing. The findings suggest that guideline and policy interventions should directly address the potential barrier of inaccurate provider self?awareness.