TY - JOUR
T1 - Emergency Department Provider Perspectives on Benzodiazepine–Opioid Coprescribing
T2 - A Qualitative Study
AU - Kim, Howard S.
AU - McCarthy, Danielle M.
AU - Hoppe, Jason A.
AU - Mark Courtney, D.
AU - Lambert, Bruce L.
N1 - Funding Information:
From the Department of Emergency Medicine, Northwestern University Feinberg School of Medicine (HSK, DMM, DMC), Chicago IL; the Department of Emergency Medicine, University of Colorado School of Medicine (JAH), Aurora, CO; the Rocky Mountain Poison & Drug Center (JAH), Denver, CO; and the Department of Communication Studies (BLL) and the Department of Medical Social Sciences (BLL), Northwestern University Feinberg School of Medicine, Chicago, IL. Received April 25, 2017; revision received July 21, 2017; accepted August 4, 2017. Scheduled for presentation at the 2017 ACEP Research Forum EMF Grant Showcase on October 30, 2017, in Washington, DC. This work was funded by the Center for Communication and Health at the Northwestern University Feinberg School of Medicine, as well as a joint mentored training award from the Emergency Medicine Foundation and the National Institute on Drug Abuse (HSK, DMC, BLL). HSK is a T32 National Research Service Award postdoctoral fellow supported by the Agency for Healthcare Research and Quality (AHRQ). DMM, DMC, and BLL receive grant funding from AHRQ for investigator-initiated research. JAH receives grant funding from the U.S. Department of Justice for investigator-initiated research. The authors have no potential conflicts to disclose. Supervising Editor: James Miner, MD. Address for correspondence and reprints: Howard S. Kim, MD, MS; e-mail: howard.kim@northwestern.edu. ACADEMIC EMERGENCY MEDICINE 2018;25:15–24.
Publisher Copyright:
© 2017 by the Society for Academic Emergency Medicine
PY - 2018/1
Y1 - 2018/1
N2 - Objective: Benzodiazepines and opioids are prescribed simultaneously (i.e., “coprescribed”) in many clinical settings, despite guidelines advising against this practice and mounting evidence that concomitant use of both medications increases overdose risk. This study sought to characterize the contexts in which benzodiazepine–opioid coprescribing occurs and providers’ reasons for coprescribing. Methods: We conducted focus groups with emergency department (ED) providers (resident and attending physicians, advanced practice providers, and pharmacists) from three hospitals using semistructured interviews to elicit perspectives on benzodiazepine–opioid coprescribing. Discussions were audio-recorded and transcribed. We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach, aiming to identify priority categories that describe the phenomenon of benzodiazepine–opioid coprescribing. Results: Participants acknowledged coprescribing rarely and reluctantly and often provided specific discharge instructions when coprescribing. The decision to coprescribe is multifactorial, often isolated to specific clinical and situational contexts (e.g., low back pain, failed solitary opioid therapy) and strongly influenced by a provider's beliefs about the efficacy of combination therapy. The decision to coprescribe is further influenced by a self-imposed pressure to escalate care or avoid hospital admission. When considering potential interventions to reduce the incidence of coprescribing, participants opposed computerized alerts but were supportive of a pharmacist-assisted intervention. Many providers found the process of participating in peer discussions on prescribing habits to be beneficial. Conclusions: In this qualitative study of ED providers, we found that benzodiazepine–opioid coprescribing occurs in specific clinical and situational contexts, such as the treatment of low back pain or failed solitary opioid therapy. The decision to coprescribe is strongly influenced by a provider's beliefs and by self-imposed pressure to escalate care or avoid admission.
AB - Objective: Benzodiazepines and opioids are prescribed simultaneously (i.e., “coprescribed”) in many clinical settings, despite guidelines advising against this practice and mounting evidence that concomitant use of both medications increases overdose risk. This study sought to characterize the contexts in which benzodiazepine–opioid coprescribing occurs and providers’ reasons for coprescribing. Methods: We conducted focus groups with emergency department (ED) providers (resident and attending physicians, advanced practice providers, and pharmacists) from three hospitals using semistructured interviews to elicit perspectives on benzodiazepine–opioid coprescribing. Discussions were audio-recorded and transcribed. We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach, aiming to identify priority categories that describe the phenomenon of benzodiazepine–opioid coprescribing. Results: Participants acknowledged coprescribing rarely and reluctantly and often provided specific discharge instructions when coprescribing. The decision to coprescribe is multifactorial, often isolated to specific clinical and situational contexts (e.g., low back pain, failed solitary opioid therapy) and strongly influenced by a provider's beliefs about the efficacy of combination therapy. The decision to coprescribe is further influenced by a self-imposed pressure to escalate care or avoid hospital admission. When considering potential interventions to reduce the incidence of coprescribing, participants opposed computerized alerts but were supportive of a pharmacist-assisted intervention. Many providers found the process of participating in peer discussions on prescribing habits to be beneficial. Conclusions: In this qualitative study of ED providers, we found that benzodiazepine–opioid coprescribing occurs in specific clinical and situational contexts, such as the treatment of low back pain or failed solitary opioid therapy. The decision to coprescribe is strongly influenced by a provider's beliefs and by self-imposed pressure to escalate care or avoid admission.
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U2 - 10.1111/acem.13273
DO - 10.1111/acem.13273
M3 - Article
C2 - 28791786
AN - SCOPUS:85030032680
SN - 1069-6563
VL - 25
SP - 15
EP - 24
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 1
ER -