Mark David Neuman, MD, is director of the Penn Center for Perioperative Outcomes Research and Transformation, chair of the Penn Medicine Opioid Task Force, and an associate professor of anesthesiology and critical care at the University of Pennsylvania in Philadelphia.
Dr. Neuman discussed the results of a recent study on opioid prescribing with Becker's ASC Review, which found that patients in the U.S. and Canada are seven times as likely as those in Sweden to receive opioids after surgery. He also explained what physicians can learn from the findings.
Note: Responses were lightly edited for style and clarity.
Question: What are the biggest barriers physicians and healthcare organizations face when trying to reduce opioid prescriptions? How can they overcome those barriers?
Dr. Mark Neuman: When we think about opioid prescribing after surgery, one key challenge healthcare organizations face is finding ways to empower and support clinicians to make positive changes in how they treat pain in this context and shift established patterns of care.
At Penn Medicine, where I chair our system's Opioid Task Force, we've seen great results from simple interventions that have used data to help clinicians improve. In a recent project, clinicians from one of our practices received feedback on how many opioid pills patients actually took after outpatient surgery, based on follow-up telephone interviews. When they saw that most patients had leftover opioids from their initial prescription, and that many patients didn't require any opioids at all for postoperative pain control, clinicians were able to decrease their postoperative prescribing with the knowledge that they weren't decreasing the quality of care they were providing, but they were actually improving quality and safety.
Q: What can U.S. physicians learn from the international disparities in opioid prescribing?
MN: The key takeaway from our study is that there are a range of different models to managing pain after surgery, and, at least for certain types of procedures, it's possible for opioids to play a less central role than they have traditionally held in the U.S. Obviously, there are big differences in culture and history between the three countries we compare in our study. But at a certain level, we are looking at the same procedures performed in similar patients, which I think can provide an impetus for U.S. providers to take another look at their own prescribing patterns.
Q: What can be done on an organizational level to successfully reduce opioid prescriptions in the U.S.?
MN: First, organizations and providers should know that there are excellent guidelines available to help practitioners right-size postoperative opioid prescriptions to meet patients' needs. Michigan OPEN has guidelines available online that are continuously updated based on new data, and are available here. The Philadelphia Department of Health has also published guidelines that can be found on the web here.
Second, organizations can work to leverage prescribing data and provider engagement to support positive practice change. At Penn Medicine, we're using a range of data-driven approaches, including prescribing dashboards, peer comparisons and individualized provider detailing, to continuously improve our own prescribing practices after surgery and in a range of other contexts.
Interested in participating in future Becker's Q&As? Email Angie Stewart: astewart@beckershealthcare.com.
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