title: Adherence to prescription opioid monitoring guidelines among residents and attending physicians in the primary care setting.
abstract: OBJECTIVE
  The aim of this study was to compare adherence to opioid prescribing guidelines and potential opioid misuse in patients of resident vs attending physicians.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  Large primary care practice at a safety net hospital in New England.
  
  
  METHODS
  Patients 18-89 years old, with at least one visit to the primary care clinic within the past year and were prescribed long-term opioid treatment for chronic noncancer pain.
  
  
  METHODS
  Data were abstracted from the electronic medical record by a trained data analyst through a clinical data warehouse. The primary outcomes were adherence to any one of two American Pain Society Guidelines: (1) documentation of at least one opioid agreement (contract) ever and (2) any urine drug testing in the past year, and evidence of potential prescription misuse defined as ≥2 early refills. We employed logistic regression analysis to assess whether patients' physician status predicts guideline adherence and/or potential opioid misuse.
  
  
  RESULTS
  Similar proportions of resident and attending patients had a controlled substance agreement (45.1% of resident patients vs. 42.4% of attending patient, P = 0.47) or urine drug testing (58.6% of resident patients vs. 63.6% of attending patients, P = 0.16). Resident patients were more likely to have two or more early refills in the past year relative to attending patients (42.8% vs. 32.5%; P = 0.004). In the adjusted regression analysis, resident patients were more likely to receive early refills (odds ratio 1.82, 95% confidence interval 1.26-2.62) than attending patients.
  
  
  CONCLUSIONS
  With some variability, residents and attending physicians were only partly compliant with national guidelines. Residents were more likely to manage patients with a higher likelihood of opioid misuse.
authors.affiliation: Section of General Internal Medicine, Boston Medical Center, School of Medicine, Boston University, Boston, Massachusetts, USA.
authors.forename: Laila
authors.initials: L
authors.lastname: Khalid
authors.forename: Jane M
authors.initials: JM
authors.lastname: Liebschutz
authors.forename: Ziming
authors.initials: Z
authors.lastname: Xuan
authors.forename: Shernaz
authors.initials: S
authors.lastname: Dossabhoy
authors.forename: Yoona
authors.initials: Y
authors.lastname: Kim
authors.forename: Denise
authors.initials: D
authors.lastname: Crooks
authors.forename: Christopher
authors.initials: C
authors.lastname: Shanahan
authors.forename: Allison
authors.initials: A
authors.lastname: Lange
authors.forename: Orlaith
authors.initials: O
authors.lastname: Heymann
authors.forename: Karen E
authors.initials: KE
authors.lastname: Lasser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D011320:Primary Health Care / Q000592:standards*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Ambulatory Monitoring; Chronic Pain; Continuing Medical Education; Pain Management; Prescription Opioids; Primary Care