Adherence to Prescription Opioid Monitoring Guidelines among Residents and Attending Physicians in the Primary Care Setting

Objective The aim of this study was to compare adherence to opioid prescribing guidelines and potential opioid misuse in patients of resident vs attending physicians. Design Retrospective cross‐sectional study. Setting Large primary care practice at a safety net hospital in N ew E ngland. Subjects Patients 18–89 years old, with at least one visit to the primary care clinic within the past year and were prescribed long‐term opioid treatment for chronic noncancer pain. Methods Data were abstracted from the electronic medical record by a trained data analyst through a clinical data warehouse. The primary outcomes were adherence to any one of two A merican P ain S ociety G uidelines: 1) documentation of at least one opioid agreement (contract) ever and 2) any urine drug testing in the past year, and evidence of potential prescription misuse defined as ≥2 early refills. We employed logistic regression analysis to assess whether patients' physician status predicts guideline adherence and/or potential opioid misuse. Results Similar proportions of resident and attending patients had a controlled substance agreement (45.1% of resident patients vs 42.4% of attending patient, P  = 0.47) or urine drug testing (58.6% of resident patients vs 63.6% of attending patients, P  = 0.16). Resident patients were more likely to have two or more early refills in the past year relative to attending patients (42.8% vs 32.5%; P  = 0.004). In the adjusted regression analysis, resident patients were more likely to receive early refills (odds ratio 1.82, 95% confidence interval 1.26–2.62) than attending patients. Conclusions With some variability, residents and attending physicians were only partly compliant with national guidelines. Residents were more likely to manage patients with a higher likelihood of opioid misuse.