Outcomes
Table 2 summarizes the prescribing patterns pre and post training. A
lower percentage of prescriptions post- training were >150
MME (21.3%) as opposed to prior to the training (45.1%) and a higher
percent were < 150 MME post-training (22.5% vs. 13.7%;
p-value for association < 0.001). Despite this shift, the
median amount prescribed remained 150 MME pre and post-intervention.
Table 3 examines prescribing patterns stratified by prescribing provider
level. Pre-intervention, there was a statistically significant
association between provider level and narcotic prescription category
(p-value = 0.03). Residents were 1.63 times more likely to prescribe
higher categories of narcotics compared to physician assistants,
fellows, and attendings (95% CI: (1.04, 2.54)). In an a priorimodel adjusted for age, race, body mass index (BMI), surgery time, prior
cesarean section, in-house infection, in-house narcotic use and whether
other procedures were performed, this association remained statistically
significant (OR= 3.42; 95% CI: (1.14,10.24); data not shown).
Post-training, all provider levels had reduced proportions of narcotic
prescriptions in the > 150 MME category. We observed large
reductions in narcotic prescriptions > 150 MME after the
training period in 2nd through 4thyear residents such that during the pre-intervention phase, 84% and
65% of 2nd and 3-4th year residents
prescribed > 150 MME respectively, compared to 22% and
28% post-intervention. In post-intervention univariate and adjusted
models, there were no statistically significant associations between
provider level and the amount category of narcotics prescribed (p-values
0.30 and 0.65 respectively). Total in-house narcotic use was observed to
be associated with higher levels of narcotics prescribed
post-intervention in univariate analysis, however this effect was not
statistically significant in the a priori adjusted model (OR>100 vs. ≤ 50 MME =1.10, 95% CI: (0.71,1.72)).
There were no patient or surgical factors that were associated with the
amount of narcotics prescribed in either univariate or multivariable
analysis. Therefore, with the exception of in-house narcotic use,
multivariable models did not yield qualitatively different results and
were thus not included. Table 4 summarizes univariate associations for
selected patient and surgical characteristics pre and post intervention.