ABSTRACT: Adherence to Prescription Opioid Monitoring Guidelines among Residents and Attending Physicians in the Primary Care Setting

OBJECTIVE:The aim of this study was to compare adherence to opioid prescribing guidelines and potential opioid misuse in patients of resident vs attending physicians.DESIGN:Retrospective cross-sectional study.SETTING:Large primary care practice at a safety net hospital in New England.SUBJECTS:Patients 18-89 years old, with at least one visit to the primary care clinic within the past year and were prescribed long-term opioid treatment for chronic noncancer pain.METHODS:Data were abstracted from the electronic medical record by a trained data analyst through a clinical data warehouse. The primary outcomes were adherence to any one of two American Pain Society Guidelines: 1 documentation of at least one opioid agreement contract ever and 2 any urine drug testing in the past year, and evidence of potential prescription misuse defined as ≥2 early refills. We employed logistic regression analysis to assess whether patients’ physician status predicts guideline adherence and/or potential opioid misuse.RESULTS:Similar proportions of resident and attending patients had a controlled substance agreement 45.1% of resident patients vs 42.4% of attending patient, P = 0.47 or urine drug testing 58.6% of resident patients vs 63.6% of attending patients, P = 0.16. Resident patients were more likely to have two or more early refills in the past year relative to attending patients 42.8% vs 32.5%; P = 0.004. In the adjusted regression analysis, resident patients were more likely to receive early refills odds ratio 1.82, 95% confidence interval 1.26-2.62 than attending patients.CONCLUSIONS:With some variability, residents and attending physicians were only partly compliant with national guidelines. Residents were more likely to manage patients with a higher likelihood of opioid misuse.

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