PCP appointment timing may affect opioid prescribing
Primary care physicians increased their opioid prescribing when appointments were later in the day or if they were running behind schedule, according to a study published in JAMA Network Open.
“These results are consistent with the idea that time pressure in medicine can affect the decisions that physicians make,” Hannah T. Neprash, PhD, an assistant professor for the division of health policy and management in the School of Public Health at the University of Minnesota, told Healio Primary Care. “Prescribing an opioid to a patient in pain may be a ‘quick fix,’ particularly when a physician is under time pressure, either because the day is almost over or because he/she is running behind schedule and trying to catch up.”
To evaluate treatment decision and appointment timing, researchers conducted a cross-sectional study using data from an electronic health record system found in primary care offices in the United States. Primary care appointments that involved patients with new painful conditions who were not given an opioid prescription within the previous year were evaluated in the study.
A total of 678,319 primary care appointments involving 642,262 patients and 5,603 PCPs were included in analyses. Within the study, the likelihood of an opioid prescription resulting from an appoint increased by 33% throughout the workday: 4% for first to third appointment vs. 5.3% for the 19th to 21st appointment (P < .001).
The likelihood of an opioid prescription increased by 17% as appointments ran late: 4.4% for 0 to 9 minutes late vs. 5.2% for 60 minutes late (P < .001).
A similar pattern was not found in NSAID prescribing or referrals to physical therapy.
Researchers noted they were not able to assess the clinical appropriateness of each opioid prescription within the study.
“Defaulting to an opioid prescription has clinical ramifications for patients, because previous research shows that even short, self-limited prescriptions of opioids can play a substantial role in transitioning to long-term opioid use,” Neprash told Healio Primary Care.
To help prevent increased opioid prescriptions when running behind schedule, Neprash said that “primary care practices might consider using ‘smart’ scheduling tools and interventions to better standardize sensitive treatment decisions (eg, shared decision-making tools) by minimizing the influence of external factors like time pressure.” – by Erin Michael
Disclosures: Neprash reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.