discharge, the importance of various factors influencing prescribing decisions, and attitudes pertaining to opioid prescribing. Decisional factors were rated on a 5-point Likert scale (1 ¼ not important, 5 ¼ very important). Responses were analyzed using descriptive statistics. Differences between provider groups were tested using Chisquared or ANOVA analyses.Results: One hundred forty-two of 203 providers completed the questionnaire for a response rate of 69.9%. The median age was 34 years and 47% were male. Among the respondents were 72 (51%) attendings, 42 (29%) residents, and 28 (20%) midlevel providers. The median number of clinical hours worked per month was 104 and median years in practice was 9. The five highest-rated decisional factors were (mean AE SD): patient's opioid prescription history (4.4 AE 0.8), patient's history of substance abuse or dependence (4.4 AE 0.7), diagnosis thought to be cause of patient's pain (4.2 AE 0.8), clinical gestalt (4.2 AE 0.7), and provider's concern about unsafe use of the medication (4.0 AE 0.9). The five lowest rated factors were: patient age (3.0 AE 1.0), patient satisfaction (3.0 AE 0.9), patient's reported pain scale (3.1 AE 1.1), the prescribing culture of the clinical site (3.1 AE 1.1), and provider's concern about medication diversion (3.3 AE 1.1). Differences between provider groups were found for several decisional factors; those with significant variation are summarized in the Table . Conclusion: There are differences in the importance of decisional factors when prescribing opioids that vary by type of ED provider. A patient's opioid prescription history and substance abuse history were among the most important factors, while patient age and satisfaction were among the least important factors. Further investigation into how ED providers make opioid prescribing decisions is warranted.
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