Variation in opioid prescribing patterns between ED providers

Area of Science:

• Emergency Medicine
• Pharmacology
• Public Health

Background:

• Opioid prescription drug abuse is a major public health crisis.
• Emergency physicians, while prescribing a small fraction of total opioids, contribute to community supply and potential diversion.
• Knowledge of current prescribing patterns is essential for effective reduction strategies.

Purpose of the Study:

• To assess the extent of variation in opioid prescribing patterns among physicians at a single institution.
• To identify physician-level differences in opioid prescription rates per patient.
• To analyze variations in the number of pills prescribed per opioid prescription.

Main Methods:

• Single-institution observational study at a community hospital ED.
• Data collected from November 2014 to July 2015 for 21 full-time providers.
• Analyzed total prescriptions, patient volume, prescriptions per patient, and pills per prescription.

Main Results:

• Opioid prescriptions were written for 12.7% of patients seen (127 per 1000 visits).
• Significant physician-level variation observed, with rates from 33 to 332 per 1000 visits.
• Substantial variation in pills per prescription (16-40% coefficient of variation) also noted.

Conclusions:

• There is significant variation in opioid prescribing practices at the individual physician level.
• This variability exists even after accounting for patient volume.
• Addressing prescribing variations may be a target for interventions to combat the opioid epidemic.