Surgeons' Perspectives on Changing the Default Number of Doses for Opioid Prescriptions in Electronic Health Record Systems.
Surgeons' Perspectives on Changing the Default Number of Doses for Opioid Prescriptions in Electronic Health Record Systems.
复制标题
外科医生对电子健康记录系统中阿片类药物处方的默认剂量数量的看法。
DOI：
10.1001/jamanetworkopen.2023.15633
复制
发表时间：
2023-05-01
影响因子：
13.8
通讯作者：
DeJonckheere, Melissa
中科院分区：
文献类型：
--
作者：
Chua, Kao-Ping;Thorne, Marc C.;Brummett, Chad M.;DeJonckheere, Melissa
这项定性研究评估了外科医生对通过电子健康记录系统向接受扁桃体切除术的青少年和年轻人开具阿片类药物处方的默认剂量变化的看法。外科医生是否注意到通过电子健康记录系统记录的接受扁桃体切除术的青少年和年轻人出院阿片类药物处方的默认剂量设置发生了变化，他们对这种干预的看法是什么？在这项定性研究中，分析了16名耳鼻喉科主治医生和住院医生的半结构化访谈，没有参与者报告注意到出院阿片类药物处方的新默认剂量设置。总体而言，参与者报告称，改变默认设置是减少其他手术人群和机构术后阿片类药物处方的一种有效且可行的方法。这些发现可以为未来的努力提供信息，以改变手术后阿片类药物处方的默认剂量设置。2021年在一家三级医疗中心进行的一项干预发现，对电子健康记录系统中的阿片类药物处方实施循证默认剂量设置，与减少对12至25岁接受扁桃体切除术的青少年和年轻人的阿片类药物处方有关。目前尚不清楚外科医生是否意识到这种干预，他们是否认为这种干预是可以接受的，或者他们是否认为类似的干预措施在其他外科人群和机构中实施是可行的。评估外科医生关于将阿片类药物处方的默认剂量数改变为循证水平的干预措施的经验和观点。这项定性研究于2021年10月在一家三级医疗中心进行，即实施干预措施1年后，通过电子健康记录系统向接受扁桃体切除术的青少年和年轻人开具阿片类药物处方的默认剂量数被降低至循证水平。半结构化的采访进行了耳鼻喉科主治和住院医生谁照顾的青少年和年轻人进行扁桃体切除术后实施的干预措施。评估了在手术后阿片类药物处方决定中发挥作用的因素以及参与者对干预的认识和看法。访谈进行了归纳编码和主题分析。分析于二零二二年三月至十二月进行。在电子健康记录系统中为接受扁桃体切除术的青少年和年轻人开具的阿片类药物处方的默认剂量设置变更。外科医生关于介入的经验和观点。16名耳鼻喉科医师中，住院医师11名（68.8%），主治医师5名（31.2%），女性8名（50.0%）。没有参与者报告注意到默认设置的变化，包括那些用新的默认阿片类药物剂量数开具阿片类药物处方的人。从访谈中，出现了4个关于外科医生对干预的看法和经验的主题：（1）阿片类药物处方决定受患者、手术、医生和卫生系统因素的影响;（2）默认可能会极大地影响处方行为;（3）对默认剂量设置干预的支持取决于其是否基于证据并产生意外后果;以及（4）改变默认剂量设置在其他外科人群和机构中是潜在可行的。这些研究结果表明，改变阿片类药物处方默认剂量设置的干预措施在各种手术人群中实施可能是可行的，特别是如果新的设置是以证据为基础的，并且如果仔细监测意外后果。
This qualitative study assesses surgeons’ perspectives regarding a change in the default number of doses for opioid prescriptions written through an electronic health record system to adolescents and young adults undergoing tonsillectomy. Did surgeons notice a change in the default dosing settings for discharge opioid prescriptions to adolescents and young adults undergoing tonsillectomy written through an electronic health record system, and what were their perspectives regarding this intervention? In this qualitative study that analyzed semistructured interviews of 16 otolaryngology attending and resident physicians, no participant reported noticing the new default dosing settings for discharge opioid prescriptions. In general, participants reported that changing default settings was a powerful and feasible way to decrease postoperative opioid prescribing in other surgical populations and institutions. These findings can inform future efforts to change the default dosing settings for opioid prescriptions written after surgery. An intervention in 2021 at a tertiary medical center found that the implementation of evidence-based default dosing settings for opioid prescriptions written in electronic health record systems was associated with reduced opioid prescribing to adolescents and young adults aged 12 to 25 years undergoing tonsillectomy. It is unclear whether surgeons were aware of this intervention, whether they thought the intervention was acceptable, or whether they believed similar interventions were feasible to implement in other surgical populations and institutions. To assess surgeons’ experiences and perspectives regarding an intervention that changed the default number of doses for opioid prescriptions to an evidence-based level. This qualitative study was conducted at a tertiary medical center during October 2021, 1 year after implementation of the intervention, in which the default number of doses for opioid prescriptions written through an electronic health record system to adolescents and young adults undergoing tonsillectomy was lowered to an evidence-based level. Semistructured interviews were conducted with otolaryngology attending and resident physicians who had cared for the adolescents and young adults undergoing tonsillectomy after implementation of the intervention. Factors that play a role in opioid prescribing decisions after surgery and participants’ awareness of and views on the intervention were assessed. The interviews were coded inductively and a thematic analysis was performed. Analyses were conducted from March to December 2022. Change in the default dosing settings for opioid prescriptions written in an electronic health record system to adolescents and young adults undergoing tonsillectomy. Surgeons’ experiences and perspectives regarding the intervention. The 16 otolaryngologists interviewed included 11 residents (68.8%), 5 attending physicians (31.2%), and 8 women (50.0%). No participant reported noticing the change in the default settings, including those who wrote opioid prescriptions with the new default number of opioid doses. From the interviews, 4 themes regarding surgeons' perceptions and experiences of the intervention emerged: (1) opioid prescribing decisions are influenced by patient, procedure, physician, and health system factors; (2) defaults may substantially influence prescribing behavior; (3) support for the default dosing setting intervention depended on whether it was evidence-based and had unintended consequences; and (4) changing the default dosing settings is potentially feasible in other surgical populations and institutions. These findings suggest that interventions to change the default dosing settings for opioid prescriptions may be feasible to implement in a variety of surgical populations, particularly if the new settings are evidence-based and if unintended consequences are carefully monitored.
登录
查看更多内容
DOI：
10.1016/j.jadohealth.2021.02.015
发表时间：
2021-05
期刊：
The Journal of adolescent health : official publication of the Society for Adolescent Medicine
影响因子：
--
作者：
DeJonckheere M;Waselewski M;Amaro X;Frank A;Chua KP
通讯作者：
Chua KP
影响因子：
4.4
作者：
DeJonckheere, Melissa;McKee, Michael M.;Zazove, Philip
通讯作者：
Zazove, Philip
DOI：
10.1016/j.jadohealth.2020.01.009
发表时间：
2020-05
期刊：
The Journal of adolescent health : official publication of the Society for Adolescent Medicine
影响因子：
--
作者：
Schuiteman S;Chua KP;Plegue MA;Ilyas O;Chang T
通讯作者：
Chang T
影响因子：
13.8
作者：
Meisenberg, Barry R.;Grover, Jennifer;Korpon, Daniel
通讯作者：
Korpon, Daniel
影响因子：
1.7
作者：
DeJonckheere M;Nichols LP;Moniz MH;Sonneville KR;Vydiswaran VGV;Zhao X;Guetterman TC;Chang T
通讯作者：
Chang T