Study: Feedback-based intervention boosts opioid prescribing adherence without worsening pain control

Editor's Note

Providing tailored feedback to surgical prescribers significantly increased adherence to opioid prescribing guidelines without affecting patients’ ability to manage postoperative pain, according to research published June 11 in JAMA Surgery. 

The study tested whether monthly reports that included peer prescribing comparisons and patient-reported outcomes could influence opioid prescribing behavior among surgical teams. Conducted within a five-hospital academic health system in Pennsylvania and New Jersey, the stepped-wedge cluster randomized clinical trial involved 143 surgical clinicians and more than 20,000 patients undergoing 30 high-volume procedures. Eligible clinicians received monthly emails summarizing how their opioid prescribing compared to health system guidelines, peer averages, and actual patient-reported pill use and pain control.

During the intervention period, the proportion of prescriptions that adhered to evidence-based guidelines increased from a baseline of 57.2% to 71.8%, with an adjusted absolute difference of 5.3% (95% CI, 2.0%–8.7%). Adherence remained above baseline in the six-month follow-up period at 74.4%, even after feedback reports stopped.

The largest improvements in prescribing practices were observed for orthopedic procedures such as knee, hip, and shoulder arthroplasty. Importantly, these gains in guideline adherence did not come at the cost of patient comfort. Patients' reported ability to manage their pain, as well as their pain scores, remained stable throughout the study.

The feedback intervention was informed by behavioral science and years of patient-reported data showing that patients typically used far fewer opioids than they were prescribed. The reports shared with clinicians included this real-world pill usage and corresponding pain scores to demonstrate how patients fared when prescriptions aligned with guidelines.

At baseline, 60% of prescriptions in the control group exceeded recommended limits. Following the intervention, every group of participating prescribers showed improvement. The study suggests that giving clinicians concrete, comparative feedback about their own prescribing—along with data showing how well patients actually managed pain—can drive meaningful reductions in excessive opioid use without compromising care, researchers write.