Enormous effort and expense have been devoted to initiatives designed to reduce opioid overprescribing, including prescription monitoring programs, clinical practice guidelines and physician education on pain management and on addiction. A new Yale University research study of almost 3,000 patients offers a simpler, cheaper strategy for promoting sensible prescribing: Lower the default number of pills in the computer program that doctors use to write prescriptions.
The study focused on surgical procedures, for which an estimated 3.3 billion prescribed opioid pills go unused every year because doctors prescribe more than patients need.
When doctors write prescriptions, they usually rely on an electronic medical record. This computer program typically includes a default number of pills that will be prescribed unless the doctor takes the time to change it.
The Yale team lowered this default from 30 to 12. Any prescriber could change the default for any patient, but remarkably, a large number of them did not. The median number of opioid pills prescribed dropped from 30 to 20.
Many doctors clearly prescribed whatever the default in the program happened to be at the time. When it shifted from 30 to 12, the proportion of opioid prescriptions for 30 pills dropped by two-thirds whereas the proportion for 12 pills increased more than ten-fold.
Two mechanisms likely explain the change. The first is that busy doctors will often minimize effort when interacting with electronic medical records.
The second phenomenon that affected the change in prescribing relates to cognitive anchoring, which is the well-documented tendency of human beings to assign weight and meaning to a number that is presented and then use that number as a baseline when considering options.
By moving the cognitive anchor in the electronic medical record, the Yale researchers nudged prescribers’ judgments about how many pills were justified.