Peer Comparison or Guideline-Based Feedback and Postsurgery Opioid Prescriptions: A Randomized Clinical Trial

Area of Science:

• Clinical Medicine
• Public Health
• Health Services Research

Background:

• Excessive opioid prescribing post-surgery contributes to prolonged use and diversion.
• Social norm-based interventions show promise in modifying prescribing behaviors.

Purpose of the Study:

• To evaluate the effectiveness of two social norm-based interventions in reducing guideline-discordant opioid prescribing after surgical procedures.

Main Methods:

• A cluster randomized clinical trial involving 19 hospitals and 3 surgical specialties.
• Interventions included email feedback on prescribing relative to institutional guidelines or peer surgeons.
• A control group received no intervention; emails targeted surgeons with >2 guideline-discordant prescriptions.

Main Results:

• Guideline-discordant prescribing decreased from 36.8% in the control group to 27.5% (peer comparison) and 25.4% (guidelines).
• Peer comparison and guideline-based feedback interventions significantly reduced guideline-discordant prescribing by 5.8 and 4.7 percentage points, respectively.
• Intervention effects were most pronounced in surgeons with higher baseline prescribing rates and surgical volumes.

Conclusions:

• Email feedback interventions, whether guideline- or peer-based, effectively reduce post-surgical opioid prescribing that deviates from guidelines.
• These interventions are simple, low-cost, scalable, and have the potential to mitigate downstream opioid misuse.
• Guideline-based feedback demonstrated comparable effectiveness to peer comparison feedback.