Describing the decision process of post-operative opioid and pain prescribing patterns in orthopedic and general surgeons

Cameron Lanier; Tyler Melton; Aaron Salwan; Misty Jenkins; Ruth Morelock; Corinne Allen; David Stewart

doi:10.5055/jom.2023.0787

Authors

Cameron Lanier, PharmD, MS https://orcid.org/0000-0002-4651-2461
Tyler Melton, PharmD, MPH
Aaron Salwan, PharmD, MPH
Misty Jenkins, RN, MSN
Ruth Morelock, RN, MSN
Corinne Allen, PharmD, MBA
David Stewart, PharmD

DOI:

https://doi.org/10.5055/jom.2023.0787

Keywords:

opioid prescribing, surgeon, behavior, integrated behavior model, pain

Abstract

Objective: To describe the post-operative opioid prescribing behaviors of orthopedic and general surgeons through the use of the Integrated Behavioral Model (IBM), and subsequently the steps and logic used by providers in determining postoperative pain prescriptions.

Design: This study was a prospective, cross-sectional, cohort study utilizing qualitative methods consisting of semistructured interviews. Data were analyzed using thematic analysis to categorize and identify themes to describe prescriber behavior.

Setting: All participants were from a regional health system in central Appalachia.

Patients and participants: Mixed population of orthopedic and general surgeons who completed residency training and performed nontraumatic procedures.

Main outcome measure: Categorization and identification of themes within the constructs of the IBM that described surgeon opioid prescribing.

Results: Fifteen surgeons participated in this study. Themes were identified within the context of the IBM. Attitudes by surgeons consisted of blame toward the government, a lack of personal screening of patients, and a theme of the abusing population of patients only being a small group. Norms were identified that included prescribing based on a standard prescribing set, realization of patient fear, and the idea of past mentality. Surgeons believed in their ability to prescribe responsibly and conservatively.

Conclusions: The prescribing patterns of surgeons and their keenness to assess patients for opioid abuse vary. Most surgeons did not actively participate in screening activities but rely on ancillary staff. Surgeons utilize federal and state laws to back prescribing patterns and thwart patient attempts for additional medications. Prescribers maintain a sense of self-confidence with their own knowledge and ability to taper and keep patients from becoming reliant on opioid prescribing.

Author Biographies

Cameron Lanier, PharmD, MS

Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City Medical Center, Ballad Health, Johnson City, Tennessee

Tyler Melton, PharmD, MPH

Assistant Professor, University of Tennessee Health Science Center College of Pharmacy, Memphis; Formerly Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee

Aaron Salwan, PharmD, MPH

Clinical Pharmacy Specialist, Behavioral Health, Department of Pharmacy, Montefiore Nyack, Nyack, New York; Formerly Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee

Misty Jenkins, RN, MSN

Johnson City Medical Center, Ballad Health, Johnson City, Tennessee

Ruth Morelock, RN, MSN

Johnson City Medical Center, Ballad Health, Johnson City, Tennessee

Corinne Allen, PharmD, MBA

Johnson City Medical Center, Ballad Health, Johnson City, Tennessee

David Stewart, PharmD

Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee

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