Clinical perspectives on hospitals\u2019 role in the opioid epidemic

Olena Mazurenko,Barbara T Andraka-Christou,Christopher A Harle,Matthew J Bair,Areeba Y Kara

doi:10.1186/s12913-020-05390-4

Abstract

BackgroundPolicymakers, legislators, and clinicians have raised concerns that hospital-based clinicians may be incentivized to inappropriately prescribe and administer opioids when addressing pain care needs of their patients, thus potentially contributing to the ongoing opioid epidemic in the United States. Given the need to involve all healthcare settings, including hospitals, in joint efforts to curb the opioid epidemic, it is essential to understand if clinicians perceive hospitals as contributors to the problem. Therefore, we examined clinical perspectives on the role of hospitals in the opioid epidemic.MethodsWe conducted individual semi-structured interviews with 23 clinicians from 6 different acute care hospitals that are part of a single healthcare system in the Midwestern United States. Our participants were hospitalists (N = 12), inpatient registered nurses (N = 9), and inpatient adult nurse practitioners (N = 2). In the interviews, we asked clinicians whether hospitals play a role in the opioid epidemic, and if so, how hospitals may contribute to the epidemic. We used a qualitative thematic analysis approach to analyze coded text for patterns and themes and examined potential differences in themes by respondent type using Dedoose software.ResultsThe majority of clinicians believed hospitals contribute to the opioid epidemic. Multiple clinicians cited Center for Medicare and Medicaid Services’ (CMS) reimbursement policy and the Joint Commission’s report as drivers of inappropriate opioid prescribing in hospitals. Furthermore, numerous clinicians stated that opioids are inappropriately administered in the emergency department (ED), potentially as a mechanism to facilitate discharge and prevent re-admission. Many clinicians also described how overreliance on pre-populated pain care orders for surgical (orthopedic) patients, may be contributing to inappropriate opioid use in the hospital. Finally, clinicians suggested the following initiatives for hospitals to help address the crisis: 1) educating patients about negative consequences of using opioids long-term and setting realistic pain expectations; 2) educating medical staff about appropriate opioid prescribing practices, particularly for patients with complex chronic conditions (chronic pain; opioid use disorder (OUD)); and 3) strengthening the hospital leadership efforts to decrease inappropriate opioid use.ConclusionsOur findings can inform efforts at decreasing inappropriate opioid use in hospitals.

Highlights

Policymakers, legislators, and clinicians have raised concerns that hospital-based clinicians may be incentivized to inappropriately prescribe and administer opioids when addressing pain care needs of their patients, potentially contributing to the ongoing opioid epidemic in the United States
We found that the majority of clinicians in our sample, regardless of the clinician’s role, perceived that hospitals are contributing to the opioid epidemic
Clinicians, who believed that hospitals are contributing to the opioid epidemic cited Centers for Medicare and Medicaid Services (CMS)’s reimbursement policy tied to patient care experience measures, and the 2000 Joint Commission’s report, as potential drivers for inappropriate opioid administration in hospitals

Summary

Introduction

Policymakers, legislators, and clinicians have raised concerns that hospital-based clinicians may be incentivized to inappropriately prescribe and administer opioids when addressing pain care needs of their patients, potentially contributing to the ongoing opioid epidemic in the United States. Policymakers, legislators, and clinicians have raised concerns that hospital-based clinicians may be incentivized to inappropriately prescribe opioids when addressing patients’ pain care needs [8]. Hospitalists (hospital-based physicians) believe that pressures to obtain high patient care experience scores promote inappropriate opioid use in the hospital [9, 10]. It is plausible to assume that hospital-based clinicians may perceive that hospitals are playing a role in opioid epidemic due to complexity of inpatient opioid prescribing

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