Do Patient Satisfaction Surveys Drive Opioid Dispensing?

Interestingly, prescriptions for opiate pain medications increased nearly 3-fold from 1991 to 2009, averaging more than 200 million prescriptions per year. In 2010, more than 19% of the prescriptions written in the United States were for opiate medications. Furthermore, the United States comprises only 4.6% of the world's population, but it consumes more than 80% of the world's opioids.

During the first half of the 1900s and back through the 1800s, physicians largely viewed pain as an integral component of the healing process. However, that all began to change during the second half of the 20th century. Through a series of events, physicians started to listen to patients when they said they were in pain.

In 1973, a landmark study by Marks and Sachar documented that 73% of hospitalized patients experienced moderate to severe pain. During this time, Irwin Press, PhD, began the process of developing patient satisfaction surveys. The question was, how can interviewing patients who are being discharged from a hospital potentially improve care?

By 1985, patient satisfaction surveys had begun, and the results were clear that patients who were provided a positive experience were more likely to have positive clinical outcomes. This foundation of surveys helped hospital executives realize that in order to improve quality, increase market share, and optimize reimbursement, they must align all aspects of the organization in an effort to improve and manage care performance.

Through the 1990s, much emphasis was placed on the development of acute pain clinical treatment guidelines, laying the foundation for current pain treatment.

In 2002, the Hospital Consumer Assessment of Health Care Providers and Systems, which was developed in joint collaboration with the US Centers for Medicare and Medicaid Services to rate hospitals, was formally endorsed by the National Quality Forum, an organization established to standardize health care quality measurement and reporting.

Over the past 50 or so years, physicians have been listening to patients regarding pain, and patients have been able to evaluate just how well they are being treated for their pain during a hospital stay through patient satisfaction surveys.

These evaluations can influence the corresponding hospital's reimbursement for the services provided by the physician on staff, so they also have the potential to influence how a physician practices at a given institution. It is not inconceivable that a physician who denies requests for opiates may not receive favorable ratings at that particular institution, which may impact their hospital privileges.

We now realize that opioid medications do play an important role in both acute and chronic pain treatment. However, non-narcotic alternatives, used in conjunction with opiate medications, may help provide reasonable pain control while decreasing the need for an increased dose of opiate therapy.