(Howard Kim, MD) ED Provider Perspectives on Analgesic Prescribing Choice: A Focus on Benzodiazepine-Opioid Co-Prescription.

Benzodiazepine and opioid analgesic medications are frequently co-prescribed from the emergency department (ED) despite a lack of evidence supporting the efficacy of combination therapy. This practice of co-prescribing poses a unique danger of synergistic respiratory depression, as evidenced by the escalating rate of overdose death due to benzodiazepine-opioid co-ingestion over the last decade. It is unclear what drives this dissonance between evidence and practice, as little is known about how ED providers choose which analgesic medication to prescribe a patient. The objective of this study is therefore to reduce the harm of benzodiazepine-opioid co-prescribing by identifying key provider-level factors involved in the process of choosing an ED analgesic prescription. This project will leverage the strengths of a multidisciplinary research team to perform an in-depth assessment of the key factors involved in this analgesic decision-making process. The specific aims of this mixed-methods study are to: (1) qualitatively characterize ED provider perspectives on the process of choosing an analgesic prescription through focus group interviews, and (2) evaluate the degree of alignment between ED provider perspectives on analgesic prescribing from qualitative interviews and actual prescribing behavior from retrospective record review. By accomplishing these aims, this research project will achieve the following publishable and/or actionable results: characterize benzodiazepine-opioid co-prescribing in a large urban academic ED, rigorously develop a conceptual model of ED analgesic prescribing behavior, and identify a target for reducing the incidence of co-prescribing in a later study. In addition to the scientific goals, this application is intended the support the eventual development of the Principal Investigator (PI) as an independent, grant-funded clinician investigator in substance abuse and addiction research. As a recent graduate of a clinical residency in emergency medicine and a current postdoctoral fellow in health services and outcomes research, the PI is well-positioned to succeed in this endeavor. Close mentorship of the applicant by the mentor and co-mentor will be facilitated by the institutional resources and prior collaborative experience of the Department of Emergency Medicine and the Center for Education in Health Sciences at Northwestern University, the latter of which will provide the PI with coursework supporting the development of qualitative and quantitative research methods and a forum to workshop study obstacles and results with other health services researchers. After successful completion of the award, the applicant will build upon study results to propose an interventional study to reduce the incidence of benzodiazepine-opioid co-prescribing as part of an application for a K or R award.