A nudge in the right direction


doctor holding up a bottle of pills

Lowering the default amount of opioid pills in EMRs may reduce prescribing in midst of an opioid crisis, new study finds

A new study published in JAMA Surgery has found lowering the default amount of opioid pills prescribed to patients in a system’s electronic medical record (EMR) was associated with a decrease in the amount of opioids prescribed system-wide.

Researchers from the Yale School of Medicine and the Connecticut Children’s Medical Center in the US lowered the default number of opioid pills in a healthcare system’s EMR from 30 to 12 (the intervention).

They then conducted a before-and-after study, looking at prescribing for 1,447 surgical procedures during the three months before the intervention, and 1,463 procedures during the three months after.

Participants were all patients in the study period undergoing one of the 10 most common operations, and discharged postoperatively by day one.

After lowering the default amount of opioid pills in the EMR, researchers found the median number of opioid pills per prescription decreased from 30 to 20.

The percentage of prescriptions for 30 opioid pills also dropped, from 40% before the intervention to 13% after.

Meanwhile the percentage of prescriptions for 12 pills increased from 2% to 25%.

Regression analysis demonstrated a decrease of 5.22 opioid pills per prescription after the intervention, for a total decrease of 34.41 morphine milligram equivalents per prescription (95% CI, – 41.36 to –27.47).

There was no statistical difference in opioid refill rates.

“Lowering the default number of opioid pills prescribed in an EMR system is a simple, effective, cheap, and potentially scalable intervention to change prescriber behaviour and decrease the amount of opioid medication prescribed after procedures,” say the authors, led by Dr Alexander Chiu, a surgery resident at the Yale School of Medicine.

“Curtailing the opioid epidemic is a national priority and requires a multifaceted approach.”

According to the authors of a linked comment, the success of the intervention is a prime example of a ‘nudge’, a concept in behavioural sciences that describes an intervention that “alters people’s behaviour in a predictable way without forbidding any options or significantly changing their economic incentives.

“A simple alteration of the decision-making context … forced prescribers to reevaluate their practices,” say the authors from the University of Toronto in Canada.

See the full study here

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