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Doctors Prescribe More Opioids Late In The Day, When Running Late

By Kelly Burch 09/09/19

Time constraints and "chaotic practice environments" may be to blame for the troubling reliance on prescriptions.

doctor overprescribes opioids while holding clock
© Diana Eller |

Doctors are significantly more likely to prescribe opioid pain pills later in the day or when their appointments are running behind schedule, according to a new study. 

The study, published in JAMA Network Open, looked at records from nearly 700,000 primary care appointments. The study authors found that doctors were 33% more likely to prescribe opioids late in their day than they were during their earlier appointments. In addition, appointments running behind schedule increased the likelihood of an opioid being prescribed by 17%. 

It’s often mentioned that time constraints on patient appointments cause doctors to turn to prescriptions, rather than engaging to find alternative treatments, a process that can take much longer. The researchers wanted to use measurements and data to see if that is truly the case. 

A Long-Suspected Factor in Overprescription

“Many observers have blamed chaotic practice environments (ie, increasing financial pressure, productivity expectations, and the cognitive effort of caring for complex patient populations) for high rates of opioid prescribing because opioids can be a quick fix for a visit where pain is a symptom,” study authors write. “The concept that time pressure can drive physician decision-making is long-standing, but little empirical literature has examined the existence of this phenomenon or its magnitude.”

They found that the theory did hold up, across all providers. 

“Physicians were significantly more likely to prescribe opioids as the workday progressed and as appointments started later than scheduled,” they wrote. 

Awareness of Bias May Help Reduce Opioid Dependence

The researchers said that there are vast difference in prescription rates between individual doctors and hospitals that can’t be explained just looking at the the time of day of appointments. However, they point out that the difference in prescribing at different times of the day can also help explain some of the difference in prescribing between different providers.

“Full-time clinicians may have higher opioid prescribing rates simply because of the effort involved in long clinical days,” they wrote. “Sharing individual data on these patterns with physicians could raise awareness of this bias and help them develop approaches such as schedule modifications to lower the burden of taxing or time-consuming decisions late in the day.”

On a national level, addressing this difference could help reduce opioid prescriptions and ultimately lead to fewer people becoming dependent on opioids. 

“If similar patterns exist in other clinical scenarios, such as managing challenging chronic illness, this phenomenon could have relevance for public health and quality improvement efforts,” the study authors write. 

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.

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