Variability in emergency physician decision making about prescribing opioid analgesics.
OBJECTIVE
The purpose of this study is to determine what factors influence emergency physicians' decisions to prescribe an opioid analgesic for 3 common, painful conditions.


METHODS
We developed items thought to influence the decision to prescribe an opioid analgesic through a review of the literature, expert consultation, and interviews with practicing emergency physicians. We developed a baseline vignette and items expected to influence the decision for each of the 3 conditions: migraine, back pain, and ankle fracture. We surveyed 650 physicians randomly selected from the American College of Emergency Physicians. The influence of individual items was explored through a univariate analysis of the response distribution. Patterns were assessed by analytically creating scales.


RESULTS
We received responses from 398 (63%) of the 634 eligible physicians. Physicians' likelihoods of prescribing an opioid showed marked variability, with at least 10% of physicians saying they were unlikely and 10% of physicians saying they were likely to prescribe for each condition. Physician responses to individual pieces of clinical information, such as the patient requesting "something strong" for the pain, were also highly variable, with at least 10% of physicians saying they would be negatively influenced by this request and at least 10% saying they would be positively influenced by it.


CONCLUSIONS
Even when faced with identical case scenarios, physicians' decisions to prescribe opioid analgesics are highly variable. Moreover, the same clinical information, such as a patient requesting a strong analgesic, changes the likelihood of prescribing opioids in opposite directions for different physicians.
Tamayo-Sarver
Joshua H
JH
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Dawson
Neal V
NV
Cydulka
Rita K
RK
Wigton
Robert S
RS
Baker
David W
DW
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D016512:Ankle Injuries / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D001416:Back Pain / Q000188:drug therapy*; D003625:Data Collection; D003657:Decision Making; D003661:Decision Support Techniques; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000188:drug therapy; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D019966:Substance-Related Disorders
D000701:Analgesics, Opioid