M. Alameddine1, O. Brown1, C. Hoban1, R. Kabeer1, H. Paulsen1, J. Silverberg1, B. VanWieren1, J. S. Lee1, M. J. Englebse1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA
Introduction:
Opioid-based pain management is contributing to an epidemic of opioid-related complications. The lack of clear guidelines in the prescription of opioid pharmaceuticals has encouraged inconsistent prescribing habits throughout the United States. Consequently, it is imperative to survey the current practice surrounding opioid-based pain management and identify detrimental trends that can be reversed via reforms in current practice guidelines. Establishing coherent protocols that unify providers in the individualized management of acute surgical pain will help to protect patients from the risk of chronic opioid dependence. The objective of this study is to characterize inconsistencies in perioperative pain management and thereby identify interventions that can most effectively encourage appropriate opioid prescribing practices.
Methods:
A 26-question survey was constructed, piloted, and finalized through a collaboration of faculty input and student-led background research. The survey evaluated providers’ knowledge of opioid pharmacology, assessed their theoretical perioperative pain management practice in case scenarios, and surveyed their provider-specific approach to opioid prescriptive practices. All opioid-prescribing health professionals at the University of Michigan Health System were invited to participate in the study. The survey was hosted in Qualtrics and distributed via a standard email invitation and link.
Results:
Of the 66 health professionals that responded to the survey (n=201), 90% do not use a risk assessment questionnaire and 89% either rarely use, never use or are not familiar with the Michigan Automated Prescription System (MAPS). 70% of providers were confident answering questions on opioid prescribing practices in a case scenario describing an uncomplicated hernia repair, and of these 46 providers, 15 (33%) described that they would prescribe less than 30 pills for postoperative pain management, while 31 (67%) would prescribe greater than 30 pills. We then compared these subgroups using an unpaired T-test and both discussed pain management prior to surgery with, on average, only 25-50% of their patients.
Conclusion:
Despite clear evidence of an opioid epidemic in this country, our study demonstrates that health professionals are not fully utilizing available resources and prescribing practice strategies that may decrease the risk of opioid-related complications. We also saw that for the same surgical case, there is variation in the number of opioid pills that physicians would prescribe for patients post-operatively. Moving forward, the goal is to further investigate why current prescribing practices exist and try to identify potential areas for intervention and improvement. Specifically, encouraging the use of standardized prescription guidelines, risk assessment questionnaires, MAPS, and longitudinal discussions regarding postoperative pain management with patients could help to mitigate the current opioid epidemic.