PHILADELPHIA— Tailored feedback to surgeons dramatically cuts excessive opioid prescriptions for common surgeries, aligning them with evidence-based guidelines without affecting patient pain control. This approach offers a promising strategy to combat the opioid crisis by aligning prescribing practices with evidence-based guidelines, addressing the critical issue of overprescribing, where excessive opioid prescriptions can lead to harmful side effects and can lead to dependence in some patients or diversion of unused pills. The findings, by researchers in the Perelman School of Medicine at the University of Pennsylvania, were published today in JAMA Surgery.
The study leveraged behavioral science and patient-reported data to nudge surgeons and supporting nurse practitioners and physician assistants to compare their prescribing practices with those of colleagues prescribing after similar procedures throughout their health system, offering a scalable model that could transform pain management while prioritizing patient safety and comfort.
"This work moves us closer to personalized pain management," said M. Kit Delgado, MD, MS, director of the Nudge Unit, Co-Chair of the Penn Medicine Opioid Task Force, and an associate professor of Emergency Medicine. "By right sizing opioid prescriptions based on patient needs by procedure, we're lowering the risk of harms while ensuring patients get the care they need."
Driven by Patient Feedback
Over the past five years, the Center for Insights to Outcomes at Penn Medicine developed a text-messaging system to track patients' pain and opioid use, revealing that patients often used far fewer pills than prescribed—for example, only 10 of 30 pills for procedures like knee surgery. This data informed the trial's guidelines and feedback approach.
"What's powerful about this approach is that it gives surgeons actionable data they can control," said Anish Agarwal, MD, MPH, chief wellness officer in the Department of Emergency Medicine and deputy director of the Center for Insights to Outcomes. "We saw every group improve, which was surprising and exciting."
The trial provided surgical prescribers with data comparing their opioid prescribing to peer averages, Penn Medicine's patient-informed guidelines. An innovative aspect of the feedback was also showing data on how many pills patients take on average after a given procedure and how well they did with managing their pain if they received a prescription within the guideline recommend amount. Conducted across multiple high-volume surgical divisions, the study showed that when surgeons had this data, there was a substantial increase in guideline adherence, and less overprescribing. Before they had the data, 60% of prescriptions for patients in the control group exceeded recommendations. Notably, these improvements were sustained even after feedback stopped, and patients' pain scores remained unchanged, ensuring effective pain management.
The study was partially funded by the US Food and Drug Administration (HHSF223201810209C) and a philanthropic grant from the Abramson Family Foundation.
