Physicians More Likely to Prescribe Opioids Later in Day

Marcia Frellick

August 02, 2018

Physicians were 60% more likely to prescribe opioids for low back pain in the last hour of a 4-hour clinical session than they were during the first hour, a study has found.

Findings by Lindsey M. Philpot, PhD, MPH, from the Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery at Mayo Clinic College of Medicine in Rochester, Minnesota, and colleagues were published July 2 in the Journal of General Internal Medicine.

Relative to the first hour of a 4-hour session (8 am - noon or 1 - 5 pm), the adjusted odds ratios of prescribing an opioid for low back pain during the second, third, and fourth hours were 1.24 (95% confidence interval [CI], 0.86-1.78; P = .245), 1.15 (95% CI, 0.81 - 1.62; P = .441), and 1.60 (95% CI, 1.09 - 2.36; P = .016).

The researchers adjusted for factors including education, employment, smoking status, providers' experience, average pain score, and scheduled appointment length.

The authors say the findings are similar to those in a 2014 study that showed the odds of prescribing antibiotics inappropriately for acute respiratory infections went up as the clinical day progressed.

Authors of the 2014 study concluded that the data showed the potential dangers of decision fatigue, a result of the accumulation of cognitive demands on physicians that makes it harder to resist the temptation of potentially inappropriate prescribing as the day wears on.

In the current study, researchers identified all patients with a primary care appointment for low back pain in 2015 at Mayo Clinic in Rochester, Minnesota, by using billing data and outpatient appointment scheduling.

Of 2772 patient visits for low back pain, almost one in five (19.8%) received an opioid prescription.

Philpot and colleagues note that low back pain is commonly reported by adults in the United States, and although opioids may be effective for the condition in the short term, there is little evidence that they are effective long-term.

The authors conclude, "As medical care becomes increasingly complex, interventions designed to reduce decision fatigue and support decision-making may serve to improve patient care and safety with opioid medications."

This study was funded by the Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery and the Mayo Clinic College of Medicine. Philpot reports funding from GSK for research not related to the current work. No other authors have disclosed any relevant financial relationships.

J Gen Intern Med. Published online July 2, 2018. Abstract

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