Clinician perceptions of electronic health record and email nudge interventions to prevent unsafe opioid prescribing: A qualitative study.

Abstract

Objective: We aimed to understand clinician perceptions of nudge interventions designed to prevent unsafe opioid prescribing for acute pain in primary care.

Design: Semistructured interviews were conducted.

Setting: Forty-eight practices across three healthcare systems were included.

Participants: Primary care clinicians who were exposed to nudge interventions as part of a randomized clinical trial were included.

Interventions: Intervention arms included an electronic health record alert upon new opioid prescribing either alone or with one or both nudge interventions (written opioid justification and/or monthly clinician comparison emails).

Main outcome measures: We used conventional content and thematic analysis to identify themes related to clinician perceptions of nudge interventions and the opioid epidemic.

Results: We conducted and analyzed 77 clinician interviews. Clinicians voiced favorable impressions of both nudge interventions, but they did not feel the nudge interventions had a direct impact on their own prescribing of opioids, perhaps due to low prescribing secondary to other opioid interventions. Clinicians felt interventions should continue to assist high opioid prescribers.

Conclusion: Nudge interventions are favorably perceived by physicians to be an additional option in the current landscape of interventions to prevent unsafe opioid prescribing for acute pain in the primary care setting.