Patient Safety and Quality
Background: The opioid epidemic is a public health crisis associated with a drop in United States (US) life expectancy, and the over prescribing of opioid medications is a major contributing factor. Changing prescribing practices are a key aspect of the US Department of Health and Human Services’ (HHS) “5-Point Strategy to Combat the Opioid Crisis”. One barrier to implementation cited by providers is concern for poorer patient satisfaction scores. Our study examines the association of reduced controlled substance (CS) prescriptions and patient satisfaction scores.
Methods: We performed a retrospective review of CS prescription data and Press Ganey satisfaction scores for patients discharged from a community hospital emergency department (ED) and two associated freestanding EDs between 01/01/18 and 11/30/18 (n = 42,511). A quality initiative (QI) to reduce CS prescribing began in July 2018. The percentage of patients discharged with a prescription for a CS was compared to rates of “Excellent” Press Ganey scores for “Overall Satisfaction”. A Pearson correlation coefficient calculation evaluated the association between CS prescription rates and patient satisfaction. Unpaired t-tests compared mean CS prescription rates and mean patient satisfaction between “pre-QI” months (January-June) and “post-QI” months (July-November).
Results: This study demonstrated no correlation between CS prescription rates (μ = 18.3, SD = 6.96) and patient satisfaction (μ = 77.4, SD = 2.51), r = -0.43, p = 0.19. A statistically significant reduction in CS prescription rates was observed between pre-QI months (μ = 23.4, SD = 2.50, n = 6) and post-QI months (μ = 12.2, SD = 6.28, n = 5), p = 0.0029, (95% CI 4.94-17.5). A statistically significant increase in patient satisfaction was observed between the pre-QI months (μ = 75.6, SD = 2.05, n = 6) and the post-QI months (μ = 79.5, SD = 1.46, n = 5), p = 0.0069, (95% CI 1.34-6.30).
Conclusion: This study demonstrates no significant association between CS prescription rates and patient satisfaction among discharged ED patients. Also, a significant decrease in CS prescription rates did not correspond to lower satisfaction scores, indicating a concern for poorer patient satisfaction should not be a barrier to implementation of HHS prescribing recommendations.