Clinician perceptions of electronic health record and email nudge interventions to prevent unsafe opioid prescribing: A qualitative study

Mia E. Lussier; Megan E. Hamm; Balchandre N. Kenkre; Eric A. Wright; Adam J. Gordon; Ajay D. Wasan; Walid F. Gellad; Andrew D. Althouse; Gerald Cochran; Gary S. Fischer; Melessa Salay; Melissa S. Kern; Kevin L. Kraemer

doi:10.5055/jom.0913

Authors

Mia E. Lussier, PharmD https://orcid.org/0000-0002-5523-0781
Megan E. Hamm, PhD
Balchandre N. Kenkre, JD
Eric A. Wright, PharmD, MPH
Adam J. Gordon, MD, MPH
Ajay D. Wasan, MD, MSc
Walid F. Gellad, MD, MPH
Andrew D. Althouse, PhD
Gerald Cochran, PhD, MSW
Gary S. Fischer, MD
Melessa Salay, MPH
Melissa S. Kern, MPH
Kevin L. Kraemer, MD, MSc

DOI:

https://doi.org/10.5055/jom.0913

Keywords:

nudges, perceptions, opioids, qualitative

Abstract

Objective: We aimed to understand clinician perceptions of nudge interventions designed to prevent unsafe opioid prescribing for acute pain in primary care.

Design: Semistructured interviews were conducted.

Setting: Forty-eight practices across three healthcare systems were included.

Participants: Primary care clinicians who were exposed to nudge interventions as part of a randomized clinical trial were included.

Interventions: Intervention arms included an electronic health record alert upon new opioid prescribing either alone or with one or both nudge interventions (written opioid justification and/or monthly clinician comparison emails).

Main outcome measures: We used conventional content and thematic analysis to identify themes related to clinician perceptions of nudge interventions and the opioid epidemic.

Results: We conducted and analyzed 77 clinician interviews. Clinicians voiced favorable impressions of both nudge interventions, but they did not feel the nudge interventions had a direct impact on their own prescribing of opioids, perhaps due to low prescribing secondary to other opioid interventions. Clinicians felt interventions should continue to assist high opioid prescribers.

Conclusion: Nudge interventions are favorably perceived by physicians to be an additional option in the current landscape of interventions to prevent unsafe opioid prescribing for acute pain in the primary care setting.

Author Biographies

Mia E. Lussier, PharmD

Clinical Assistant Professor, Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, Pennsylvania; Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, New

Megan E. Hamm, PhD

Director of Qualitative, Evaluation, and Stakeholder Engagement Research Services, Association Director of Qualitative Analysis, CRHC Data Center; Assistant Professor of Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Balchandre N. Kenkre, JD

Research Assistant, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Eric A. Wright, PharmD, MPH

System Director, Center for Pharmacy Innovation and Outcomes; Professor of Pharmacy, Department of Bioethics and Decision Sciences, Geisinger, Danville, Pennsylvania

Adam J. Gordon, MD, MPH

Professor of Medicine and Psychiatry, Associate Chief of Epidemiology, Director, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, University of Utah School of Medicine; VA Salt Lake City Healthcare System, Salt Lake City, Utah

Ajay D. Wasan, MD, MSc

Vice Chair for Pain Medicine, Professor of Anesthesiology and Perioperative Medicine and Psychiatry, Director, Center for Innovation in Pain Care, Director, Chronic Pain Research Program, Departments of Anesthesiology & Perioperative Medicine, and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Walid F. Gellad, MD, MPH

Professor of Medicine, Professor of Health Policy and Management, Director, Center for Pharmaceutical Policy and Prescribing, Center for Research on Health Care, University of Pittsburgh School of Medicine; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

Andrew D. Althouse, PhD

Assistant Professor of Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Gerald Cochran, PhD, MSW

Professor, Department of Internal Medicine, Director of Research for the Program on Addiction Research, Clinical Care, Knowledge and Advocacy, Program for Addiction Research, Clinical Care, Knowledge and Advocacy, University of Utah School of Medicine; VA Salt Lake City Healthcare System, Salt Lake City, Utah

Gary S. Fischer, MD

Professor of Medicine and Biomedical Informatics, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Melessa Salay, MPH

Scientific Program Director, TREETOP Research Center, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Melissa S. Kern, MPH

Program Manager, Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, Pennsylvania

Kevin L. Kraemer, MD, MSc

Professor of Medicine and Clinical and Translational Science, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

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