Doctors more likely to prescribe opioids later in the day

In a new study, researchers examined how primary care physicians decide whether to prescribe opioid painkillers.

They found doctors are more likely to prescribe opioid painkillers as the day wears on and when they’re running behind schedule.

The research was conducted by a team from the University of Minnesota and Harvard University.

It’s only human that decision-making changes when people are rushed.

In the new study, the team examined this phenomenon—using a national source of electronic health records.

They looked at primary care appointments for patients with no history of opioid use within the past year and who were being treated for their first complaint of a painful condition.

They tested for an association between appointment timing (i.e., time-of-day and whether the appointment started later than scheduled), pain treatment decisions (e.g., opioid painkillers and nonsteroidal anti-inflammatory drugs, such as aspirin), and referrals to physical therapy.

The results showed that doctors prescribed more opioid painkillers later in the day and when they’re running behind schedule.

But this pattern was not found in nonsteroidal anti-inflammatory drug prescriptions or physical therapy referrals.

The team says these findings support the widespread perception among providers that time pressure to provide a ‘quick fix’ is one reason why opioids are frequently prescribed in the United States.

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 team plans to expand the research to test whether appointment timing is linked to other decisions that have major public health relevance such as antibiotic prescribing and chronic disease management.

The lead author of the study is Hannah Neprash, an assistant professor in the School of Public Health.

The study is published in JAMA Network Open.

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