Importance Prescription opioids play a significant role in the ongoing opioid crisis. Guidelines and physician education have had mixed success in curbing opioid prescriptions, highlighting the need for other tools that can change prescriber behavior, including nudges based in behavioral economics. Objective To determine whether and to what extent changes in the default settings in the electronic medical record (EMR) are associated with opioid prescriptions for patients discharged from emergency departments (EDs). Design, Setting, and Participants This quality improvement study randomly altered, during a series of five 4-week blocks, the prepopulated dispense quantities of discharge prescriptions for commonly prescribed opioids at 2 large, urban EDs. These changes were made without announcement, and prescribers were not informed of the study itself. Participants included all health care professionals (physicians, nurse practitioners, and physician assistants) working clinically in either of the 2 EDs. Data were collected from November 28, 2016, through July 9, 2017, and analyzed from July 16, 2017, through May 14, 2018. Interventions Default quantities for opioids were changed from status quo quantities of 12 and 20 tablets to null, 5, 10, and 15 tablets according to a block randomization scheme. Regardless of the default quantity, each health care professional decided for whom to prescribe opioids and could modify the quantity prescribed without restriction. Main Outcomes and Measures The primary outcome was the number of tablets of opioid-containing medications prescribed under each default setting. Results A total of 104 health care professionals wrote 4320 prescriptions for opioids during the study period. Using linear regression, an increase of 0.19 tablets prescribed (95% CI, 0.15-0.22) was found for each tablet increase in default quantity. When evaluating each of the 15 pairwise comparisons of default quantities (eg, 5 vs 15 tablets), a lower default was associated with a lower number of pills prescribed in more than half (8 of the 15) of the pairwise comparisons; there was a higher quantity in 1 and no difference in 6 comparisons. Conclusions and Relevance These findings suggest that default settings in the EMR may influence the quantity of opioids prescribed by health care professionals. This low-cost, easily implementable, EMR-based intervention could have far-reaching implications for opioid prescribing and could be used as a tool to help combat the opioid epidemic. Trial Registration ClinicalTrials.gov identifier: NCT04155229.

中文翻译：

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默认电子病历设置与急诊科阿片类药物处方的医疗保健专业人员模式的关联

重要性 处方阿片类药物在持续的阿片类药物危机中发挥着重要作用。指导方针和医师教育在遏制阿片类药物处方方面取得了不同的成功，突出表明需要其他可以改变处方者行为的工具，包括基于行为经济学的推动。目的 确定电子病历 (EMR) 中默认设置的变化是否以及在多大程度上与急诊科 (ED) 出院的患者的阿片类药物处方有关。设计、设置和参与者 这项质量改进研究在 5 个为期 4 周的系列中随机改变了 2 个大型城市 ED 中常用阿片类药物的预配出药量。这些变化是在没有公告的情况下做出的，并且开药者没有被告知这项研究本身。参与者包括在 2 个 ED 中的任何一个进行临床工作的所有医疗保健专业人员（医师、执业护士和医师助理）。数据收集时间为 2016 年 11 月 28 日至 2017 年 7 月 9 日，分析时间为 2017 年 7 月 16 日至 2018 年 5 月 14 日。 10 片和 15 片根据块随机化方案。无论默认数量如何，每个医疗保健专业人员都可以决定为谁开阿片类药物，并且可以不受限制地修改处方数量。主要结果和措施 主要结果是在每个默认设置下开出的含阿片类药物的药片数量。结果 在研究期间，共有 104 名医疗保健专业人员为阿片类药物开出了 4320 张处方。使用线性回归，发现默认数量每增加 0.19 片处方药（95% CI，0.15-0.22）。在评估默认数量的 15 个成对比较中的每一个时（例如，5 片对 15 片），在成对比较的一半以上（15 个中的 8 个）中，较低的默认值与较少的药丸数量相关；1 中的数量较多，6 次比较中没有差异。结论和相关性 这些发现表明 EMR 中的默认设置可能会影响医疗保健专业人员开出的阿片类药物的数量。这种低成本、易于实施、基于 EMR 的干预可能对阿片类药物处方产生深远影响，并可用作帮助对抗阿片类药物流行的工具。试验注册 ClinicalTrials.gov 标识符：NCT04155229。