Primary care physicians and neurologists with poor quality ratings prescribe opioids and butalbital medications to headache patients at significantly higher rates than top-performing counterparts, according to an analysis conducted by the healthcare clinical navigation company Grand Rounds.
For the analysis, researchers assessed physician prescribing data and Grand Rounds quality rankings for more than 96 percent of the nation's practicing physicians to determine prescribing patterns for headache patients.
Primary care physicians with overall quality rates in the bottom 10 percent were 1.9 times more likely to prescribe oxycodone for headaches, 3.4 times more likely to prescribe hydrocodone and 5.0 times more likely to prescribe butalbital compared to top-performing primary care physicians. Among neurologists, those rated in the bottom 10 percent were 1.5 times more likely to prescribe oxycodone, 2.8 times more likely to prescribe hydrocodone and 4.1 times more likely to prescribe butalbital.
While hydrocodone, oxycodone and butalbital can provide short-term headache relief, they are meant to be treatments of last resort, as they can worsen headache severity over time — a condition known as medication overuse headache — and increase addiction risk.
"The disparity in prescribing across physicians suggests a patient's chances of developing medication overuse headache can be dramatically reduced by simply ensuring that they are treated by a doctor who understands the risks associated with opioids and barbiturates and knows to use them only as a line of last resort," Nate Freese, senior director of data strategy with Grand Rounds, wrote in a blogpost. "For the patient, this can mean the difference between a quick, effective course of treatment and a life-altering addiction … Many healthcare challenges are exceptionally difficult to solve. When it comes to treating a headache, simply seeing the right doctor can make all the difference."
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