The Association of Patient Satisfaction-Based Incentives with Primary Care Physician Opioid Prescribing

Conclusions

Although most family physicians reported no impact of patient satisfaction surveys on their decision to prescribe opioids, those reporting financial incentives for survey results were more likely to report such an impact. A low response rate, lack of directionality of reported impact, and physician self-reporting as opposed to assessment of actual opioid prescription data limit the generalizability of these preliminary results. Further research is needed to correlate actual opioid prescribing practices with patient-satisfaction-based incentives. Meanwhile, our findings are consistent with reports of potentially adverse effects from efforts to improve patient satisfaction. In a study assessing the relationship between patient satisfaction and outcomes, higher patient satisfaction was associated with increased health care costs and mortality.² There is insufficient evidence to support the concept that patient satisfaction surveys alone reflect the true quality of care.³ Furthermore, institutional pressure to achieve high scores on such surveys might create an inadvertent pressure to prescribe more opioids.

Family physicians may be less willing to prescribe opioids for chronic nonmalignant pain compared with acute pain or cancer pain. This has been demonstrated by other studies over the past 2 decades and is readily apparent in the medical community.⁴ In 2016, the Centers for Disease Control and Prevention published guidelines for prescribing opioids for chronic pain, which may better guide appropriate prescribing.⁵ Further study of the potential dilemma of balancing patient satisfaction with responsible opioid prescribing is suggested to effectively address the current opioid epidemic in the United States.