Abstract
Context:
The number of deaths due to opioid overdose has steadily increased in the United States since the early 2000s. The US opioid epidemic calls for an urgent need to evaluate physician prescribing habits.
Objective:
To educate obstetrics and gynecology residents about opioid abuse, the quantity typically prescribed postoperatively, and strategies to decrease adverse outcomes.
Methods:
Obstetrics and gynecology residents at an urban safety-net hospital were given a preintervention evaluation to understand their opioid prescribing patterns and use of resources like prescription drug monitoring programs and opioid risk tool. Residents then attended a didactic session reviewing rates of adverse outcomes from overprescribing, resources to reduce adverse outcomes, and the number of opioids considered appropriate postoperatively. Residents completed an immediate postintervention evaluation to reevaluate prescribing patterns.
Results:
Pre- and postintervention evaluations were completed by 13 residents. In the preintervention evaluation, all participants reported that they would prescribe at least 30 opioid pills for patients after cesarean delivery, but in the postintervention evaluation, none reported that they would prescribe more than 20 opioid pills (P=<.0001). Similar but less distinct shifts can be seen in laparoscopic hysterectomy and the use of preoperative gabapentinoids (ie, gabapentin and pregabalin). Before the intervention, 7 residents (54%) reported that they currently prescribed 20 opioid pills or more for patients after laparoscopic hysterectomy, whereas after the intervention, 1 resident (7.7%) reported that he or she would prescribe more than 20 opioid pills in (P=.0382). Before the intervention, 2 residents (15.4%) reported that they would consider gabapentinoids compared with 13 residents (100%) after the intervention.
Conclusion:
Focused opioid education can reduce the intended number of opioid pills prescribed in a postoperative setting. This study highlights the effect that educational curricula can have on physician prescribing patterns to help mitigate the current epidemic and help optimize stepwise multimodal analgesia to avoid overprescribing opioids.
Since the early 2000s, the number of deaths due to opioid overdose has continuously increased and created an epidemic across the United States, which suggests the need to evaluate physician prescribing habits.
1 Studies
2-5 have indicated that patients frequently take fewer opioid pills than prescribed after major procedures and are left with excess pills.
2-5 Obstetrics and gynecology (OB/GYN) physicians have a unique opportunity to affect prescribing patterns because cesarean delivery and laparoscopic hysterectomy are 2 of the most common surgeries performed in women.
6 One study
4 reported that 53% of patients took fewer than 5 pills after cesarean delivery, and 83% of patients took less than half of the total amount prescribed. Another study
5 indicated that physicians frequently prescribed twice the number of opioids that patients used after a hysterectomy.
5 One study
7 found that physicians may be unaware of the degree to which overprescribing has played a role in the opioid epidemic. These patterns highlight the need for a change in current prescribing practices, and enhancing physician education may lead to improved opioid prescribing habits.
7,8
Evidence-based opioid quantity prescribing could decrease potential diversion and misuse of these medications. The purpose of this study was to educate OB/GYN residents about the increasing rates of opioid abuse and overdose, the number of opioid pills typically used by patients postoperatively, and the strategies to decrease adverse outcomes. We hypothesized that residents would make a change in their prescribing recommendations after the intervention.
Thirteen of 26 (50%) OB/GYN residents attended the OPE lecture and completed both the pre- and postintervention evaluations. The postintervention evaluations reflected what the residents intended to prescribe after attending the OPE lecture. Four of 14 participants (30.8%) reported having had prior controlled substance education. In the preintervention evaluation, 10 participants (76.9%) reported that they would never use prescription drug monitoring programs, and none had used the opioid risk tool. None of the residents reported prescribing opioids for patients at discharge for routine vaginal deliveries. For cesarean deliveries, 13 participants (100%) reported in the preintervention evaluation that they would prescribe at least 30 pills, but none would prescribe more than 20 pills in the postintervention evaluation. After the OPE lecture, 10 participants (76.9%) reported that they would prescribe 20 pills, and 3 participants (23.1%) reported that they would prescribe 15 pills.
Before the OPE, 7 participants (53.8%) said that they would prescribe 20 opioid pills or more for a patient undergoing laparoscopic hysterectomy for benign disease, and after the OPE, 1 participant (7.7%) said that he or she would prescribe more than 20 pills. Postintervention results were found by dividing the total number of preintervention evaluations by the total number of postintervention evaluations. These results showed a relative reduction of 37.1% of pills that would be prescribed after cesarean delivery and a relative reduction of 27.1% of pills that would be prescribed after laparoscopic hysterectomy. The prescription of perioperative gabapentinoids was characterized as always, mostly, sometimes, and never. Eleven participants (84.6%) reported that they would never prescribe gabapentinoids before the OPE lecture, and 11 residents (84.6%) reported that gabapentinoids would be “always” or “mostly” used after the OPE lecture. The
Table provides a comparison of results using the Fisher exact test.
Table.
Postsurgical Analgesic Prescribing Intentions Among OB/GYN Residents Before and After an Opioid Educational Intervention (N=13)
Prescription recommendation | Preintervention evaluation, No. (%) | Postintervention evaluation, No. (%) | Total | P valuea |
Cesarean delivery, No. of opioids | | | | <.0001 |
15 | 0 | 3 (23.1) | 3 (11.5) | |
20 | 0 | 10 (76.9) | 10 (38.5) | |
30 | 13 (100) | 0 | 13 (50) | |
| | | | |
Laparoscopic hysterectomy, No. of opioids | | | | .0382 |
5 | 1 (7.7) | 1 (7.7) | 2 (7.7) | |
10 | 0 | 3 (23.1) | 3 (11.5) | |
15 | 5 (38.5) | 8 (61.5) | 13 (50) | |
20 | 2 (15.4) | 1 (7.7) | 3 (11.5) | |
30 | 5 (38.5) | 0 | 5 (19.2) | |
| | | | |
Gabapentinoids | | | | <.0001 |
Always | 0 | 3 (23.1) | 3 (11.5) | |
Mostly | 0 | 8 (61.5) | 8 (30.8) | |
Sometimes | 2 (15.4) | 2 (15.4) | 4 (15.4) | |
Never | 11 (84.6) | 0 | 11 (42.3) | |
Table.
Postsurgical Analgesic Prescribing Intentions Among OB/GYN Residents Before and After an Opioid Educational Intervention (N=13)
Prescription recommendation | Preintervention evaluation, No. (%) | Postintervention evaluation, No. (%) | Total | P valuea |
Cesarean delivery, No. of opioids | | | | <.0001 |
15 | 0 | 3 (23.1) | 3 (11.5) | |
20 | 0 | 10 (76.9) | 10 (38.5) | |
30 | 13 (100) | 0 | 13 (50) | |
| | | | |
Laparoscopic hysterectomy, No. of opioids | | | | .0382 |
5 | 1 (7.7) | 1 (7.7) | 2 (7.7) | |
10 | 0 | 3 (23.1) | 3 (11.5) | |
15 | 5 (38.5) | 8 (61.5) | 13 (50) | |
20 | 2 (15.4) | 1 (7.7) | 3 (11.5) | |
30 | 5 (38.5) | 0 | 5 (19.2) | |
| | | | |
Gabapentinoids | | | | <.0001 |
Always | 0 | 3 (23.1) | 3 (11.5) | |
Mostly | 0 | 8 (61.5) | 8 (30.8) | |
Sometimes | 2 (15.4) | 2 (15.4) | 4 (15.4) | |
Never | 11 (84.6) | 0 | 11 (42.3) | |
×