“Hard” and “soft” patient cues that influence ED prescribing for potential opioid misusers

• Published in: The American journal of emergency medicine Vol. 33; no. 1; pp. 109 - 111
• Main Authors: Mannina, Lisa, MD, Capt, USAF, MC, Varney, Shawn M., MD, Col, USAF, MC, Bebarta, Vikhyat S., MD, Lt Col, USAF, MC, Ganem, Victoria J., RN, MSN, Carey, Kathy R., CRM, Ramos, Rose G
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2015; Elsevier Limited
• Subjects: Adult; Analgesics, Opioid - therapeutic use; Anti-inflammatory agents; Back pain; Cues; Emergency; Emergency medical care; Emergency Service, Hospital; Female; Hospitals; Humans; Male; Medical records; Middle Aged; Nonsteroidal anti-inflammatory drugs; Opioid-Related Disorders - diagnosis; Pain; Pain - drug therapy; Practice Patterns, Nurses' - statistics & numerical data; Practice Patterns, Physicians' - statistics & numerical data; Studies; Surveys and Questionnaires
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2014.09.034

[...]most providers were male, and approximately one-half were residents practicing for less than 5 years. EMPs (n = 90) First choice Second choice Patient provides unbelievable stories or exaggerated explanations 26 10 Excessive ED visits for pain 20 10 Patient looks comfortable from a distance but in severe pain when you enter the room 17 21 Patient refers to drugs by name 15 23 When you present your plan for analgesia (NSAIDs), patient states, "That never works!" 6 11 History is inconsistent with presentation 4 11 Excuses for missing clinic appointments 1 2 Patient reports not enough money to fill prescription so needs more medications now 1 2 Table 3 Ranking of patient characteristics providers used as soft signs for opioid misuse Abbreviation: NSAIDs, nonsteroidal antiinflammatory drugs.