Despite a decline in the number of opioid prescriptions issued by surgeons, patient-reported satisfaction scores have remained constant, according to study data published in JAMA Surgery. As such, researchers contend that concerns over patient satisfaction should not be a barrier to adopting clinical guidelines that encourage reduced opioid prescription.
Investigators conducted a retrospective analysis of opioid prescribing trends at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. Opioid prescription data were abstracted from medical records in 2 periods: before (period A) and after (period B) an educational intervention aimed at reducing overprescription was delivered to surgeons. Period A took place between May 1, 2015, and December 31, 2015; period B covered July 1, 2016, through June 20, 2017. A patient satisfaction survey was administered in both periods to capture any association between opioid prescribing trends and patient satisfaction with care.
Overall, data were obtained from 996 patients who underwent 5 common outpatient procedures with 11 surgeons. Mean (±standard deviation) patient age was 58±15 years, and the majority (67%) were women. The proportion of patients prescribed opioids decreased from 90.2% to 72.8% from period A to period B (P <.001). For patients who were prescribed opioids, the mean (±standard deviation) number of pills per prescription decreased from 28.3 ± 15 to 13.3 ± 8 (P <.001). All 11 surgeons significantly decreased the number of opioid pills they prescribed; in 10 surgeons, the mean number of pills decreased by 50% or more. Of 996 patients, 105 responded to the satisfaction survey (10.5%): 37 in period A and 68 in period B.
No difference in mean (±standard deviation) patient satisfaction ratings were observed between period A and period B (9.70 ± 0.7 vs 9.65 ± 0.7 out of 10; P =.69). A total of 640 surveys were collected for the 11 study clinicians, including surveys of encounters not associated with the index surgery. No overall difference in mean satisfaction ratings for all surveys were observed between period A and period B (9.55 ± 1.3 vs 9.59 ± 0.9; P =.62). When individual clinicians were analyzed, none had significant changes in satisfaction ratings between periods.
Limitations of the study included the fact that data were collected at only 1 study site, which reduced generalizability. In addition, survey response rates were low; an unknown bias may exist between responders and nonresponders.
Even so, these results support recent efforts to limit opioid overprescribing. “Concern about clinician satisfaction scores should not be a barrier to reducing opioid prescribing,” the investigators wrote.
Louie CE, Kelly JL, Barth RJ Jr. Association of decreased postsurgical opioid prescribing with patients’ satisfaction with surgeons [published online October 16, 2019]. JAMA Surg. doi:10.1001/jamasurg.2019.2875