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. 2015 Mar;16(3):480-7.
doi: 10.1111/pme.12602. Epub 2014 Dec 19.

Adherence to prescription opioid monitoring guidelines among residents and attending physicians in the primary care setting

Laila Khalid  1 , Jane M Liebschutz, Ziming Xuan, Shernaz Dossabhoy, Yoona Kim, Denise Crooks, Christopher Shanahan, Allison Lange, Orlaith Heymann, Karen E Lasser
Affiliations

Adherence to prescription opioid monitoring guidelines among residents and attending physicians in the primary care setting

Laila Khalid et al. Pain Med. 2015 Mar.

Abstract

Objective: The aim of this study was to compare adherence to opioid prescribing guidelines and potential opioid misuse in patients of resident vs attending physicians.

Design: Retrospective cross-sectional study.

Setting: Large primary care practice at a safety net hospital in New England.

Subjects: Patients 18-89 years old, with at least one visit to the primary care clinic within the past year and were prescribed long-term opioid treatment for chronic noncancer pain.

Methods: Data were abstracted from the electronic medical record by a trained data analyst through a clinical data warehouse. The primary outcomes were adherence to any one of two American Pain Society Guidelines: (1) documentation of at least one opioid agreement (contract) ever and (2) any urine drug testing in the past year, and evidence of potential prescription misuse defined as ≥2 early refills. We employed logistic regression analysis to assess whether patients' physician status predicts guideline adherence and/or potential opioid misuse.

Results: Similar proportions of resident and attending patients had a controlled substance agreement (45.1% of resident patients vs. 42.4% of attending patient, P = 0.47) or urine drug testing (58.6% of resident patients vs. 63.6% of attending patients, P = 0.16). Resident patients were more likely to have two or more early refills in the past year relative to attending patients (42.8% vs. 32.5%; P = 0.004). In the adjusted regression analysis, resident patients were more likely to receive early refills (odds ratio 1.82, 95% confidence interval 1.26-2.62) than attending patients.

Conclusions: With some variability, residents and attending physicians were only partly compliant with national guidelines. Residents were more likely to manage patients with a higher likelihood of opioid misuse.

Keywords: Ambulatory Monitoring; Chronic Pain; Continuing Medical Education; Pain Management; Prescription Opioids; Primary Care.

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Conflict of interest statement

Disclosure/Conflicts of Interest: No conflicts of Interest

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