Opioid-Prescribing Practices in Plastic Surgery: A Juxtaposition of Attendings and Trainees

Joseph, Walter J.; Cuccolo, Nicholas G.; Chow, Ian; Moroni, Elizabeth A.; Beers, Emily H.

doi:10.1007/s00266-019-01588-y

Cited by 7 publications

(22 citation statements)

References 38 publications

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“…As compared with attendings, junior and senior residents are significantly more likely to prescribe additional opioids to avoid patient phone calls. 45 This is consistent with our previous study that found that plastic surgery trainees in the United States prescribed significantly more opioids than their Canadian counterparts for 7 of 8 procedures surveyed. 3 This identifies a very crucial knowledge gap among surgical residents that the OPE intervention in this study aims to address.…”

Section: Types Of Interventions To Improve Prescribing Behaviorsupporting

confidence: 91%

“…20 The remaining studies focused their provider intervention solely on the dissemination of prescribing guidelines for various operations. [37][38][39][40][41][42][43][44] Furthermore, Joseph et al 45 recently highlighted the need for education on postoperative pain management for plastic surgery trainees. They found that residents across a wide geographical spread of Accreditation Council for Graduate Medical Education-accredited plastic surgery residency programs are significantly less comfortable than attendings with prescribing opioid analgesics.…”

Section: Types Of Interventions To Improve Prescribing Behaviormentioning

confidence: 99%

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An Education Intervention to Raise Awareness Reduces Self-reported Opioid Overprescribing by Plastic Surgery Residents

et al. 2022

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The aim of this study was to understand how opioid prescribing practices of plastic surgery residents changed after instituting opioid prescribing education (OPE) interventions. Methods: Plastic surgery residents at a single academic institution completed a survey (fall 2017) assessing opioid prescribing following 8 common procedures. The Division then completed 3 multidisciplinary OPE interventions over 2.5 years, which provided passive learning to raise awareness without top-down prescribing guidelines. Residents were resurveyed at 2 time points after the interventions (fall 2018 and spring 2020). The primary outcome measure was self-reported morphine milligram equivalents prescribed. Results: Survey response rates were 84% to 100%. Preintervention opioid prescriptions were characterized by high variability and absolute doses for all procedures. We observed statistically significant decreases in prescribed doses for most procedures at 9 months post intervention and further decreases at 2.5 years. In the most recently surveyed cohort, only 3 of 16 residents (18.8%) had OPE before residency, whereas 12 of 16 residents (75.0%) participated in OPE during residency. Eighty-eight percent of respondents "always" (8/16, 50%) or "usually" (6/16, 38%) considered the opioid epidemic when prescribing opioids, suggesting an improved prescribing culture. Barriers to better prescribing included duplicate prescriptions/accessing state-run prescription drug monitoring programs (75.0%), remote prescribing (75%), providing refills (56%), and prescribing opioids for patients on chronic opioid therapy (56%). Conclusion: This prospective cohort study demonstrates that a simple multidisciplinary, didactic OPE intervention that aimed to increase residents' awareness has the potential to reduce self-reported opioid prescribing and sustain prescribing practices over many years. We identify persistent barriers facing our resident prescribers today, enabling more opioid educational interventions in the future.

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Section: Types Of Interventions To Improve Prescribing Behaviorsupporting

confidence: 91%

Section: Types Of Interventions To Improve Prescribing Behaviormentioning

confidence: 99%

An Education Intervention to Raise Awareness Reduces Self-reported Opioid Overprescribing by Plastic Surgery Residents

et al. 2022

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“…Additionally, the literature is conflicting regarding whether surgical trainees prescribe more or less opioids compared with attendings. 26 , 27 Thus, this was unlikely to contribute to the change in prescribing patterns. Third, we were unable to assess the narcotic prescription refills at outside hospitals.…”

Section: Discussionmentioning

confidence: 99%

The Effect of an Electronic Prescribing Policy for Opioids on Physician Prescribing Patterns Following Common Upper Extremity Procedures

Shoji¹,

Bernstein²,

Merchan³

et al. 2022

Journal of Hand Surgery Global Online

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Purpose: We evaluated physician prescribing patterns before and after the implementation of a statemandated opioid electronic prescribing (ePrescribing) program after 4 common outpatient hand surgeries. Specifically, we aimed to answer the following: (1) is there a change in the number of opioids prescribed after the institution of ePrescribing for carpal tunnel release (CTR), ganglion excision, distal radius fracture (DRF) open reduction internal fixation (ORIF), and carpometacarpal (CMC) arthroplasty and ( 2) what factors are associated with an increased number of tablets or total morphine milligram equivalents (MMEs) prescribed. Methods: We retrospectively reviewed patients who underwent CTR, ganglion excision, DRF ORIF, or CMC arthroplasty and analyzed the number of tablets and MMEs prescribed before and after the policy implementation, as well as which factors were associated with an increased total number of opioid tablets and MMEs prescribed. Results: A total of 428 patients were included. After policy implementation, there was a significant decrease in MMEs prescribed for ganglion excision (68 [SD, 45] vs 50 [SD, 60], P ¼ .03) and CMC arthroplasty (283 [SD, 147] vs 217 [SD, 92], P < .01). There was also a significant decrease in the total number of tablets prescribed for ganglion excision (11 [SD, 5.7] vs 6.8 [SD, 8.0], P < .01), CMC arthroplasty (36 [SD,13] vs 29 [SD, 12], P < .01), and DRF ORIF (31 [SD, 8.6] vs 28 [SD, 8.5], P ¼ .04). The number of patients receiving any opioid prescription also significantly decreased following CTR (30% vs 51%, P ¼ .03) and ganglion excision (11% vs 53%, P < .01). Conclusions: The initiation of state-mandated ePrescribing was associated with a decreased number of opioidsdboth MMEs and tabletsdprescribed after surgery by hand surgeons for a variety of common procedures. Furthermore, a greater percentage of patients received no opioid prescriptions after ePrescribing. These findings support the value of ePrescribing as a potential tool to further decrease excess opioid prescriptions. Type of study/level of evidence: Therapeutic III.

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“…Despite this, our absolute number of responses is comparable to or greater than most resident-based surveys in the plastic surgery literature. 28 , 54 Furthermore, nonresponder analysis demonstrated that survey participants are a representative sample of eligible participants. ( See document, Supplemental Digital Content 3, which displays the nonresponder analysis.…”

Section: Discussionmentioning

confidence: 99%

Are US Plastic Surgery Residents Equipped to Face the Opioid Epidemic? A National Survey

Sharif‐Askary¹,

Abdou²,

Singh³

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary: The United States opioid epidemic is among this century’s most profound threats to public health and demands that all physicians consider their role in reversing its trajectory. Previous literature demonstrated that plastic surgery trainees lack vital practices that promote opioid stewardship. However, it is not understood why this practice gap exists. This is a national survey-based study evaluating the availability and effectiveness of opioid education in US plastic surgery programs. A total of 91 residents completed the survey. Our study found that there is an unmet need for practical and comprehensive training regarding safe opioid prescribing among plastic surgery trainees. “Informal training,” defined as the “learn as you go” method, was found to be more common than formal training and considerably more valuable according to trainees. Trainees cited real-world applicability of informal training and that it comes from teachers whom they know and trust as valuable attributes of this type of education. Furthermore, the severity of the opioid epidemic has not translated into improved trainee education, as there was no significant difference in knowledge on safe opioid prescribing practices between junior and senior residents. To change the course of the epidemic, plastic surgery programs need to better train younger generations who believe they are critical stakeholders. This study lays the framework for the “formalization of informal training,” and the creation of practical and efficacious educational initiatives.

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Opioid-Prescribing Practices in Plastic Surgery: A Juxtaposition of Attendings and Trainees

Cited by 7 publications

References 38 publications

An Education Intervention to Raise Awareness Reduces Self-reported Opioid Overprescribing by Plastic Surgery Residents

An Education Intervention to Raise Awareness Reduces Self-reported Opioid Overprescribing by Plastic Surgery Residents

The Effect of an Electronic Prescribing Policy for Opioids on Physician Prescribing Patterns Following Common Upper Extremity Procedures

Are US Plastic Surgery Residents Equipped to Face the Opioid Epidemic? A National Survey

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