Clinicians who reduce their postsurgical opioid prescriptions have no reason to fear a decrease in their patient satisfaction scores—provided they educate patients appropriately.
Findings from a retrospective study published in JAMA Surgery show that an opioid stewardship program at Dartmouth-Hitchcock Medical Center in New Hampshire had no effect on the overall clinician satisfaction rating assigned by patients after their procedure, even after slashing opioid prescriptions by more than 50%.
The study’s authors identified fear of inadequate pain control causing poor reviews from patients as a potential barrier for hospitals looking to institute opioid stewardship programs. Because some satisfaction scores are tied to hospital reimbursement, those fears could potentially hit a clinician’s bottom line if realized.
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The study’s findings should dispel those fears, according to co-author Richard Barth Jr., M.D., chief of the section of general surgery at Dartmouth-Hitchcock Medical Center. However, he notes one important caveat: Patient education was a major component of the organization’s opioid-reduction program.
“Setting expectations for patients about using non-opioid ways to take care of their pain and talking to patients about it before the surgery lets them know you care about their discomfort—we care about your pain,” Barth told FierceHealthcare.
He notes that one way his organization has managed to slash the number of opioids they prescribe to postsurgical patients has been to explain upfront that many patients don’t need any opioids to manage their pain. Instead, most can make do with non-opioid alternatives. It’s also important to let patients know that they can get opioids if it turns out they need them.
While managing patients’ expectations upfront, Barth also suggests discussing proper disposal of any extra opioid pills with patients, so that even if the reduced number of pills a clinician prescribes winds up being too much, they won’t end up being diverted.
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Figuring out the right number of pills to prescribe continues to be a work in progress. The intervention at Dartmouth-Hitchcock aimed to prescribe enough opioids to satisfy 80% of postsurgical patients. Even after cutting their prescriptions by more than half, only three patients required refills after the stewardship system went into place—approximately the same number as requested refills beforehand.
Those numbers suggest the guidelines for how many opioid pills patients need continue to be a moving target, in part driven by the evidence produced by interventions like the one Barth and his colleagues undertook.
“We were concerned that maybe we wouldn’t satisfy everyone, so we set [the 80%] guidelines,” Barth said. “But then we found that it didn’t happen. So for some of those operations now the numbers that we gave in the paper are probably a little too high.”
He points to current prescribing recommendations issued by the Michigan Opioid Prescribing Engagement Network as a good basis for hospitals and clinicians as they try to target the right level of opioid prescriptions. He also notes that where they once ranged from five to 10, current recommendations for many types of surgeries start at zero.
“We initially said we should give patients from breast cancer surgery operations like five pills or something, but now with the last 200 patients I’ve done, 95% or so have been treated without any opioids,” Barth said. “So these guidelines are changing as more studies are done.”