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Emergency physician risk assessment practices prior to prescribing opioids

  • Original Research
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Canadian Journal of Emergency Medicine Aims and scope Submit manuscript

Abstract

Background

Safer opioid prescribing remains a crucial issue for emergency physicians. Policy statements and guidelines recommend deliberate risk assessment for likelihood of current or future opioid use disorder prior to prescribing opioids. However, the practice patterns of emergency physicians remain underreported.

Methods

We surveyed emergency physicians across Canada about their local opioid prescribing policies, their practice patterns of risk assessment prior to prescribing opioids, and which clinical risk factors they find most important.

Results

The response rate was 20.4% (n = 312/1532). 59.8% of respondents report usually or always assessing for risk. Physicians rely on gestalt (80.3%), targeted histories based on risk factors in the literature (55.6%) or their experience (57.6%), and reviewing medical (83.1%) and medication records (75.6%). Contacting primary prescribers is uncommon (16.3%). A minority routinely use opioid prescribing risk assessment tools (6.4%), have local opioid prescribing policies (27%), or make use of electronic medical record functions to assist risk stratifying (2.4%).

Conclusion

Many Canadian emergency physicians make risk assessments based on gestalt rather than identifying literature-based risk factors. This conflicts with guidelines calling for routine comprehensive assessment. Further efforts should be directed towards education in optimizing risk assessment; and towards system-level initiatives such as clear local prescribing policies, electronic-systems functionality, and developing assessment tools for use in the ED.

Résumé

Contexte

La prescription sûre d'opioïdes reste un enjeu essentiel pour les médecins d'urgence. Avant de prescrire des opioïdes, les énoncés de politique et les lignes directrices recommandent une évaluation des risques bien réfléchie pour la probabilité d’un abus d'opiacé actuel ou éventuel. Cependant, les modalités de pratique des médecins urgentistes font l’objet d’une documentation et d’une information insuffisante.

Méthodes

Nous avons mené une enquête auprès des médecins urgentistes partout au Canada au sujet de leurs politiques locales de prescription des opioïdes, de leurs modalités de pratique d'évaluation des risques avant de prescrire des opioïdes, et des facteurs de risque cliniques qu'ils jugent les plus importants.

Résultats

Le taux de réponse était de 20.4% (n = 312/1532). 59.8% des répondants déclarent évaluer habituellement ou toujours le risque. Les médecins dépendent du gestalt (80.3%), des antécédents ciblés basés sur des facteurs de risque de la littérature (55.6%) ou de leur expérience (57.6%) et d’une examination des dossiers médicaux (83.1%) et des dossiers pharmaceutiques (75.6%). Il est rare de contacter les principaux prescripteurs (16.3%). Une minorité utilise régulièrement des outils d'évaluation des risques liés à la prescription des opioïdes (6.4%), dispose de politiques locales de prescription d'opiacés (27%) ou utilise les fonctions de dossier médical électronique pour aider à la stratification des risques (2.4%).

Conclusion

De nombreux médecins urgentistes canadiens évaluent les risques en se basant sur la gestalt plutôt que sur l’identification des facteurs de risque documentés. Cela est en contradiction avec les directives exigeant une évaluation complète de routine. Des efforts supplémentaires devraient être dirigés vers l'éducation pour optimiser l’évaluation des risques; et vers des initiatives au niveau du système telles que des politiques de prescription locales claires, la fonctionnalité des systèmes électroniques et l'élaboration d’outils d'évaluation à utiliser aux urgences.

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Acknowledgements

The authors would like to thank Angela Marcantonio for her assistance in this study.

Funding

Funding was generously provided by an academic grant from the Department of Emergency Medicine at The Ottawa Hospital.

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Authors and Affiliations

  1. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada

    Mark McKinney & Ian G. Stiell

  2. Clinical Epidemiology Program, F6, Ottawa Hospital Research Institute, 1053 Carling Ave, Box 685, Ottawa, ON, K1Y 4E9, Canada

    Ian G. Stiell

  3. Department of Critical Care Medicine, Queensway-Carleton Hospital, Ottawa, ON, Canada

    Magdalena Kisilewicz

Authors
  1. Mark McKinney
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  2. Magdalena Kisilewicz
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  3. Ian G. Stiell
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Correspondence to Ian G. Stiell.

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McKinney, M., Kisilewicz, M. & Stiell, I.G. Emergency physician risk assessment practices prior to prescribing opioids. Can J Emerg Med 23, 351–355 (2021). https://doi.org/10.1007/s43678-020-00066-8

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  • DOI: https://doi.org/10.1007/s43678-020-00066-8

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