title: Pilot Study of the Importance of Factors Affecting Emergency Department Opioid Analgesic Prescribing Decisions.
abstract: Little is known about the factors driving decision-making among emergency department (ED) providers when prescribing opioid analgesics (OA). The aim of this pilot study was to identify the importance of factors influencing OA-prescribing decisions and to determine how this varied among different types of providers.
  
  
  
  This was an observational cross-sectional survey study of 203 ED providers. The importance of decisional factors was rated on a 5-point Likert scale. Differences between provider groups were tested using Chi-squared or ANOVA tests where applicable.
  
  
  
  Overall, 142/203 (69.9 %) potential respondents participated in the study. The five highest-rated factors were (mean ± SD) patient's opioid prescription history (4.4 ± 0.8), patient's history of substance abuse or dependence (4.4 ± 0.7), diagnosis thought to be the cause of patient's pain (4.2 ± 0.8), clinical gestalt (4.2 ± 0.7), and provider's concern about unsafe use of the medication (4.0 ± 0.9). The importance of 6 of 21 decisional factors varied significantly between different groups of providers.
  
  
  
  In this pilot study of ED providers, the self-reported importance of several factors influencing OA-prescribing decisions were significantly different among attending physicians, resident physicians, and advanced practice providers. Further investigation into how ED providers make OA-prescribing decisions is needed to help guide interventions aimed at improving appropriate pain management.
authors.affiliation: Department of Emergency Medicine, Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA. adam.pomerleau@emory.edu.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Pomerleau
authors.affiliation: Department of Emergency Medicine, Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Schrager
authors.affiliation: Department of Emergency Medicine, Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA.
authors.forename: Brent W
authors.initials: BW
authors.lastname: Morgan
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D004635:Emergency Medicine / Q000193:education / Q000379:methods*; D004636:Emergency Service, Hospital; D005845:Georgia; D005863:Gestalt Theory; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D009722:Nurse Practitioners; D059408:Pain Management / Q000379:methods*; D010823:Physician Assistants; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D055502:Secondary Prevention; D057566:Self Report; D019966:Substance-Related Disorders / Q000517:prevention & control; D000078329:Workforce
chemical_list: D000701:Analgesics, Opioid
keywords: Opioid prescribing; Pain management; Prescription drug abuse