Racial and Ethnic Disparities in Discharge Opioid Prescribing From a Hospital Medicine Service

2021 ◽  
Vol September 2021 - Online First ◽  
Author(s):  
Aksharananda Rambachan ◽  
Margaret C Fang ◽  
Priya Prasad ◽  
Nicholas Iverson
Keyword(s):  
General Medicine ◽  
Prescribing Patterns ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Asian Patients ◽  
Medicine Service ◽  
Black Patients ◽  
To Receive ◽  
Population Rate ◽  
White Patients

BACKGROUND: Differential opioid prescribing patterns have been reported in non-White patient populations. However, these disparities have not been well described among hospitalized medical inpatients. OBJECTIVE: To describe differences in opioid prescribing patterns among inpatients discharged from the general medicine service based on race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS: For this retrospective study, we performed a multivariable logistic regression for patient race/ethnicity and whether patients received an opioid prescription at discharge and a negative binomial regression for days of opioids prescribed at discharge. The study included all 10,953 inpatients discharged from the general medicine service from June 2012 to November 2018 at University of California San Francisco Medical Center who received opioids during the last 24 hours of their hospitalization. MAIN OUTCOMES AND MEASURES: We examined two primary outcomes: whether a patient received an opioid prescription at discharge, and, for patients prescribed opioids, the number of days dispensed. RESULTS: Compared with White patients, Black patients were less likely to receive an opioid prescription at discharge (predicted population rate of 47.6% vs 50.7%; average marginal effect [AME], −3.1%; 95% CI, −5.5% to −0.8%). Asian patients were more likely to receive an opioid prescription on discharge (predicted population rate, 55.6% vs 50.7%; AME, +4.9; 95% CI, 1.5%-8.3%). We also found that Black patients received a shorter duration of opioid days compared with White patients (predicted days of opioids on discharge, 15.7 days vs 17.8 days; AME, −2.1 days; 95% CI, −3.3 to −0.9). CONCLUSION: Black patients were less likely to receive opioids and received shorter courses at discharge compared with White patients, adjusting for covariates. Asian patients were the most likely to receive an opioid prescription.

scholarly journals A Retrospective Review of Opioid Prescribing Practices for At-Risk Pediatric Populations Undergoing Ambulatory Surgery

2021 ◽  
Vol 27 (1) ◽  
pp. 51-56
Author(s):  
Sterling Lee ◽  
Ashley Reid ◽  
Suhong Tong ◽  
Lori Silveira ◽  
James J. Thomas ◽  
...  
Keyword(s):  
At Risk ◽  
Ambulatory Surgery ◽  
Outpatient Surgery ◽  
Prescribing Patterns ◽  
Inpatient Setting ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Pediatric Populations ◽  
To Receive

OBJECTIVE Pediatric patients with sleep-disordered breathing (SDB) and obesity are at risk for opioid-induced respiratory depression. Although monitoring in the inpatient setting allows for early recognition of opioid-related adverse events, there is far less vigilance after ambulatory surgery as patients are discharged home. Guidelines for proper opioid dosing in these pediatric subsets have not been established. We sought to determine if at-risk children were more likely to receive doses of opioids outside the recommended range. METHODS Baseline opioid prescribing data for all outpatient surgery patients receiving an opioid prescription between January 2019 and June 2020 were retrospectively reviewed. Patients with SDB or obesity were identified. To obtain more information about prescribing practices, we analyzed patient demographics, size descriptors used for calculations, and prescription characteristics (dose, duration, and prescribing surgical service). RESULTS A total of 4674 patients received an opioid prescription after outpatient surgery. Of those, 173 patients had SDB and 128 were obese. Surgical subspecialties rendering most of the opioid prescriptions included otolaryngology and orthopedics. Obese patients were more likely (64%) to be prescribed opioids using ideal weight at higher mg/kg doses (>0.05 mg/kg; 83.3%; p < 0.0001). When providers used actual body weight, lower mg/kg doses were more likely to be used (53.7%; p < 0.0001). No prescriptions used lean body mass. CONCLUSIONS Overweight/obese children were more likely to receive opioid doses outside the recommended range. Variability in prescribing patterns demonstrates the need for more detailed guidelines to minimize the risk of opioid-induced respiratory complications in vulnerable pediatric populations.

Trends in Postoperative Opioid Prescribing in Outpatient Pediatric Surgery

Pain Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 1789-1795
Author(s):  
Gabrielle C Donohoe ◽  
Bingqing Zhang ◽  
Janell L Mensinger ◽  
Ronald S Litman
Keyword(s):  
Incidence Rate ◽  
Outpatient Surgery ◽  
Private Insurance ◽  
Duration Of Treatment ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Dose Number ◽  
Race Ethnicity ◽  
To Receive ◽  
Directional Trend

Abstract Objective To determine trends in opioid prescribing for home use after pediatric outpatient surgery. Design Retrospective analysis of a de-identified database. Setting Multispecialty children’s hospital and freestanding surgery centers. Patients, Participants A total of 65,190 encounters of pediatric outpatient surgeries from 2013 through 2017 for nine different surgical specialties. Patients in the cardiothoracic service and nonpainful procedures were excluded. Main Outcome Measures. Incidence rate of prescribing, dose, number of doses available (i.e., duration of therapy), and maximum weight-based home opioid availability from 2013 to 2017. Additional independent variables included sex, age, weight, race/ethnicity, insurance type (private vs public), and surgical service. Results The incidence rate of receiving a take-home opioid prescription at discharge ranged from 18% to 21% between 2013 and 2017, with no clear directional trend. Among patients prescribed opioids, however, the maximum available take-home dose steadily declined from 2013 through 2017 (P < 0.001). This was due to both a decrease in the number of doses prescribed (i.e., duration of treatment) and, beginning in 2015, the amount per dose. Females were more likely to receive an opioid than males, and patients with public insurance were more likely to receive an opioid than those with private insurance. Opioid prescribing was more likely in patients who did not disclose their ethnicity and those of ethnic minority compared with white patients (all P < 0.0001). Conclusions The rate of receiving a take-home opioid prescription and the dose prescribed remained stable from 2013 to 2017, but the duration of treatment steadily declined, and beginning in 2015, the amount per dose also decreased. Certain subgroups of patients were more likely to be prescribed opioids and will require further investigation and confirmation.

scholarly journals Opioid Prescribing Patterns for Low Back Pain Among Commercially Insured Children

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tej D Azad ◽  
Michael D Harries ◽  
Daniel Vail ◽  
Yi Jonathan Zhang ◽  
John K Ratliff
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Prescribing Patterns ◽  
Low Back ◽  
Age Group ◽  
Newly Diagnosed ◽  
Opioid Prescription ◽  
Opioid Prescribing

Abstract INTRODUCTION Low back pain (LBP) may affect up to 20% of the pediatric population. No specific guidelines exist regarding pharmacotherapy for acute LBP in the pediatric population. Given this observation and the lack of data available regarding pharmacotherapy for pediatric LBP, we sought to characterize patterns of opioid prescribing in the pediatric population. METHODS We used a national database to identify pediatric patients (age 5-17) with newly diagnosed with LBP between 2008 and 2015 who did not have a red flag diagnosis, had not received an opioid prescription in the 6 mo prior to diagnosis, and had 12-mo of continuous enrollment after diagnosis. We used logistic regression to model the association between sex, geographic region, categorical age, and our primary outcome, receipt of an opioid prescription in the year following diagnosis. RESULTS Our sample included 268 228 opioid-naïve pediatric patients diagnosed with LBP between 2008 and 2015. We observed that 47 631 (17.8%) patients received physical therapy, 29 903 (11.2%) patients received chiropractic manipulative therapy, 658 (0.25%) patients received epidural steroid injection, and 281 (0.10%) patients received surgery. A total of 35 274 (13.2%) pediatric LBP patients were prescribed opioids within 12 mo from their diagnosis. Opioid prescribing decreased in all age groups over the study period age group 5 to 9 decreased from 4.2% to 2.7%, age group 10 to 14 decreased from 10.3% to 7.7%, and age group 15 to 18 yr decreased from 20.9% to 17.1%. Female pediatric patients were more likely than male patients to receive an opioid prescription (OR, 1.12, P < .0001). Patients ages 10 to 14 (OR, 2.89, P < .0001) and 15 to 18 (OR, 6.98, P < .0001) were significantly more likely to be prescribed opioids compared to patients in the youngest age group. CONCLUSION To our knowledge, we report the first observational cohort study of opioids and LBP in the pediatric population. Our findings indicate that opioids are being used for newly diagnosed LBP and receipt of opioids are associated with patient demographic factors.

scholarly journals Reduction in Hospital System Opioid Prescribing for Acute Pain Through Default Prescription Preference Settings: Pre–Post Study

10.2196/24360 ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. e24360
Author(s):  
Benjamin Heritier Slovis ◽  
Jeffrey M Riggio ◽  
Melanie Girondo ◽  
Cara Martino ◽  
Bracken Babula ◽  
...  
Keyword(s):  
The United States ◽  
Prescribing Patterns ◽  
Duration Of Treatment ◽  
Opioid Prescription ◽  
Hospital System ◽  
Opioid Prescribing ◽  
Before And After ◽  
Control And Prevention ◽  
Prescribing Practice ◽  
Quasi Experimental

Background The United States is in an opioid epidemic. Passive decision support in the electronic health record (EHR) through opioid prescription presets may aid in curbing opioid dependence. Objective The objective of this study is to determine whether modification of opioid prescribing presets in the EHR could change prescribing patterns for an entire hospital system. Methods We performed a quasi-experimental retrospective pre–post analysis of a 24-month period before and after modifications to our EHR’s opioid prescription presets to match Centers for Disease Control and Prevention guidelines. We included all opioid prescriptions prescribed at our institution for nonchronic pain. Our modifications to the EHR include (1) making duration of treatment for an opioid prescription mandatory, (2) adding a quick button for 3 days’ duration while removing others, and (3) setting the default quantity of all oral opioid formulations to 10 tablets. We examined the quantity in tablets, duration in days, and proportion of prescriptions greater than 90 morphine milligram equivalents/day for our hospital system, and compared these values before and after our intervention for effect. Results There were 78,246 prescriptions included in our study written on 30,975 unique patients. There was a significant reduction for all opioid prescriptions pre versus post in (1) the overall median quantity of tablets dispensed (54 [IQR 40-120] vs 42 [IQR 18-90]; P<.001), (2) median duration of treatment (10.5 days [IQR 5.0-30] vs 7.5 days [IQR 3.0-30]; P<.001), and (3) proportion of prescriptions greater than 90 morphine milligram equivalents/day (27.46% [10,704/38,976; 95% CI 27.02%-27.91%] vs 22.86% [8979/39,270; 95% CI 22.45%-23.28%]; P<.001). Conclusions Modifications of opioid prescribing presets in the EHR can improve prescribing practice patterns. Reducing duration and quantity of opioid prescriptions could reduce the risk of dependence and overdose.

Current Opioid Prescribing Patterns after Microdirect Laryngoscopy

2019 ◽  
Vol 129 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Molly N. Huston ◽  
Rouya Kamizi ◽  
Tanya K. Meyer ◽  
Albert L. Merati ◽  
John Paul Giliberto
Keyword(s):  
The United States ◽  
Opioid Abuse ◽  
Prescribing Patterns ◽  
Opioid Analgesia ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Opioid Prescribing

Background: The prevalence of opioid abuse has become epidemic in the United States. Microdirect laryngoscopy (MDL) is a common otolaryngological procedure, yet prescribing practices for opioids following this operation are not well characterized. Objective: To characterize current opioid-prescribing patterns among otolaryngologists performing MDL. Methods: A cross-sectional survey of otolaryngologists at a national laryngology meeting. Results: Fifty-eight of 205 physician registrants (response rate 28%) completed the survey. Fifty-nine percent of respondents were fellowship-trained in laryngology. Respondents performed an average of 13.3 MDLs per month. Thirty-four percent of surgeons prescribe opioids for over two-thirds of their MDLs, while only 7% of surgeons never prescribe opioids. Eighty-eight percent of surgeons prescribed a combination opioid and acetaminophen compound, hydrocodone being the most common opioid component. Many surgeons prescribe non-opioid analgesics as well, with 70% and 84% of surgeons recommending acetaminophen and ibuprofen after MDL respectively. When opioids were prescribed, patient preference, difficult exposure and history of opioid use were the most influential patient factors. Concerns of opioid abuse, the physician role in the opioid crisis, and literature about postoperative non-opioid analgesia were also underlying themes in influencing opioid prescription patterns after MDL. Conclusions: In this study, over 90% of practicing physicians surveyed are prescribing opioids after MDL, though many are also prescribing non-opioid analgesia as well. Further studies should be completed to investigate the needs of patients following MDL in order to allow physicians to selectively and appropriately prescribe opioid analgesia postoperatively.

scholarly journals 3377 A cross-sectional analysis of opioid prescribing patterns among gynecologic oncologists using Medicare fee-for service provider utilization & payment data

2019 ◽  
Vol 3 (s1) ◽  
pp. 31-31
Author(s):  
David Samuel ◽  
Devin Miller ◽  
Sara Isani ◽  
Dennis Kuo ◽  
Gregory Gressel
Keyword(s):  
National Level ◽  
Adverse Outcomes ◽  
Prescribing Patterns ◽  
Fee For Service ◽  
Years Of Experience ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Exact Test ◽  
Opioid Prescribing ◽  
National Medical

OBJECTIVES/SPECIFIC AIMS: Opioids are the first-line treatment for moderate to severe cancer-related pain. Increased awareness of opioid prescription misuse and adverse outcomes has prompted statements on their use from multiple national medical groups. In this study we characterize national-level opioid prescription patterns among gynecologic oncologists treating Medicare beneficiaries. METHODS/STUDY POPULATION: The Centers for Medicare and Medicaid Services (CMS) database was used to access Medicare Part D beneficiary data (2016). All available opioid claims prescribed by gynecologic oncologists were identified. Medication type, prescription length and other prescribing factors were recorded. Physician demographics were obtained from departmental websites and accrediting bodies. Physicians with <10 opioid claims are not included in the CMS database. Bivariate statistical analysis including chi-squared, Fisher’s exact test and Wilcoxon rank-sum test were performed to compare variables with threshold for significance set at p<0.05. Linear regression modeling was also performed to examine association of gender with number of opioids prescribed. RESULTS/ANTICIPATED RESULTS: A total of 494 board-certified gynecologic oncologists were included in this analysis. In 2016, gynecologic oncologists wrote 23,584 opioid prescriptions for 267,824 days of treatment (average of 9.24 prescribed days per claim). The most commonly prescribed opioid was oxycodone/acetaminophen (41%). Male physicians had significantly more opioid prescription claims than females (p<0.01) including after adjusting for differences in years of experience. The majority of physicians had 11-50 opioid prescription claims (68%). A minority were high prescribing physicians with >100 opioid claims (11%). Of these, the overwhelming majority were male (82%) and late career (46%, >15 years since board certification). Physicians in the South had the greatest number of opioid prescription claims and significantly more than physicians in the Northeast, who had the fewest (p<0.01). Mean number of opioid claims increased with increasing years of experience (p<0.05). DISCUSSION/SIGNIFICANCE OF IMPACT: Among gynecologic oncologists, there were gender-based, regional and experience-related variations in opioid prescribing in the Medicare population in 2016. Further longitudinal studies are required to elucidate secular trends in opioid prescription practice.

scholarly journals Racial Differences in Predictors of Intensive End-of-Life Care in Patients With Advanced Cancer

2009 ◽  
Vol 27 (33) ◽  
pp. 5559-5564 ◽  
Author(s):  
Elizabeth Trice Loggers ◽  
Paul K. Maciejewski ◽  
Elizabeth Paulk ◽  
Susan DeSanto-Madeya ◽  
Matthew Nilsson ◽  
...  
Keyword(s):  
End Of Life ◽  
Racial Differences ◽  
Advanced Cancer ◽  
Do Not Resuscitate ◽  
Advanced Cancer Patients ◽  
Black Patients ◽  
Patient Reported ◽  
Eol Care ◽  
To Receive ◽  
White Patients

Purpose Black patients are more likely than white patients to receive life-prolonging care near death. This study examined predictors of intensive end-of-life (EOL) care for black and white advanced cancer patients. Patients and Methods Three hundred two self-reported black (n = 68) and white (n = 234) patients with stage IV cancer and caregivers participated in a US multisite, prospective, interview-based cohort study from September 2002 to August 2008. Participants were observed until death, a median of 116 days from baseline. Patient-reported baseline predictors included EOL care preference, physician trust, EOL discussion, completion of a Do Not Resuscitate (DNR) order, and religious coping. Caregiver postmortem interviews provided information regarding EOL care received. Intensive EOL care was defined as resuscitation and/or ventilation followed by death in an intensive care unit. Results Although black patients were three times more likely than white patients to receive intensive EOL care (adjusted odds ratio [aOR] = 3.04, P = .037), white patients with a preference for this care were approximately three times more likely to receive it (aOR = 13.20, P = .008) than black patients with the same preference (aOR = 4.46, P = .058). White patients who reported an EOL discussion or DNR order did not receive intensive EOL care; similar reports were not protective for black patients (aOR = 0.53, P = .460; and aOR = 0.65, P = .618, respectively). Conclusion White patients with advanced cancer are more likely than black patients with advanced cancer to receive the EOL care they initially prefer. EOL discussions and DNR orders are not associated with care for black patients, highlighting a need to improve communication between black patients and their clinicians.

scholarly journals Creating opioid dependence in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 100-103 ◽  
Author(s):  
Suneel Upadhye
Keyword(s):  
Emergency Department ◽  
Opioid Dependence ◽  
Prescribing Patterns ◽  
Clinical Question ◽  
Emergency Physicians ◽  
Naive Patient ◽  
Opioid Prescription ◽  
Opioid Prescribing

Clinical questionWhat is the risk of creating opioid dependence from an ED opioid prescription?Article chosenBarnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med 2017;376:663-73, doi:10.1056/NEJMsa1610524.ObjectiveThis study examined the risk of creating long-term opioid dependence from a prescription written in an opioid-naive patient in the ED.

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