How Physician Self-Perceptions Affect the Impact of Peer Comparison Feedback on Opioid Prescribing.

Autor:	Liao JM; Department of Medicine, University of Washington School of Medicine, Seattle, WA.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA., Sun C; Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Yan XS; Sutter Health, Sacramento, CA., Patel MS; Ascension, St. Louis, MO., Small DS; Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, PA., Isenberg WM; Sutter Health, Sacramento, CA., Landa HM; Sutter Health, Sacramento, CA., Bond BL; Sutter Health, Sacramento, CA., Rareshide CAL; Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Volpp KG; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.; Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Delgado MK; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.; Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Lei VJ; Massachusetts General Hospital, Boston, MA., Shen Z; Sutter Health, Sacramento, CA., Navathe AS; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.; Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Jazyk:	angličtina
Zdroj:	American journal of medical quality : the official journal of the American College of Medical Quality [Am J Med Qual] 2023 May-Jun 01; Vol. 38 (3), pp. 129-136. Date of Electronic Publication: 2023 Apr 05.
DOI:	10.1097/JMQ.0000000000000117
Abstrakt:	Peer comparison feedback is a promising strategy for reducing opioid prescribing and opioid-related harms. Such comparisons may be particularly impactful among underestimating clinicians who do not perceive themselves as high prescribers relative to their peers. But peer comparisons could also unintentionally increase prescribing among overestimating clinicians who do not perceive themselves as lower prescribers than peers. The objective of this study was to assess if the impact of peer comparisons varied by clinicians' preexisting opioid prescribing self-perceptions. Subgroup analysis of a randomized trial of peer comparison interventions among emergency department and urgent care clinicians was used. Generalized mixed-effects models were used to assess whether the impact of peer comparisons, alone or combined with individual feedback, varied by underestimating or overestimating prescriber status. Underestimating and overestimating prescribers were defined as those who self-reported relative prescribing amounts that were lower and higher, respectively, than actual relative baseline amounts. The primary outcome was pills per opioid prescription. Among 438 clinicians, 54% (n = 236) provided baseline prescribing self-perceptions and were included in this analysis. Overall, 17% (n = 40) were underestimating prescribers whereas 5% (n = 11) were overestimating prescribers. Underestimating prescribers exhibited a differentially greater decrease in pills per prescription compared to nonunderestimating clinicians when receiving peer comparison feedback (1.7 pills, 95% CI, -3.2 to -0.2 pills) or combined peer and individual feedback (2.8 pills, 95% CI, -4.8 to -0.8 pills). In contrast, there were no differential changes in pills per prescription for overestimating versus nonoverestimating prescribers after receiving peer comparison (1.5 pills, 95% CI, -0.9 to 3.9 pills) or combined peer and individual feedback (3.0 pills, 95% CI, -0.3 to 6.2 pills). Peer comparisons were more impactful among clinicians who underestimated their prescribing compared to peers. By correcting inaccurate self-perceptions, peer comparison feedback can be an effective strategy for influencing opioid prescribing. (Copyright © 2023 the American College of Medical Quality.)
Databáze:	MEDLINE
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