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Patient prescriber agreements, also known as opioid contracts or opioid treatment agreements, have been recommended as a strategy for mitigating non-medical opioid use (NMOU). The purpose of our study was to characterize the proportion of patients with PPAs, the rate of non-adherence, and clinical predictors for PPA completion and non-adherence. This retrospective study covered consecutive cancer patients seen at a palliative care clinic at a safety net hospital between 1 September 2015 and 31 December 2019. We included patients 18 years or older with cancer diagnoses who received opioids. We collected patient characteristics at consultation and information regarding PPA. The primary purpose was to determine the frequency and predictors of patients with a PPA and non-adherence to PPAs. Descriptive statistics and multivariable logistic regression models were used for the analysis. The survey covered 905 patients having a mean age of 55 (range 18–93), of whom 474 (52%) were female, 423 (47%) were Hispanic, 603 (67%) were single, and 814 (90%) had advanced cancer. Of patients surveyed, 484 (54%) had a PPA, and 50 (10%) of these did not adhere to their PPA. In multivariable analysis, PPAs were associated with younger age (odds ratio [OR] 1.44; p = 0.02) and alcohol use (OR 1.72; p = 0.01). Non-adherence was associated with males (OR 3.66; p = 0.007), being single (OR 12.23; p = 0.003), tobacco (OR 3.34; p = 0.03) and alcohol use (OR 0.29; p = 0.02), contact with persons involved in criminal activity (OR 9.87; p < 0.001), use for non-malignant pain (OR 7.45; p = 0.006), and higher pain score (OR 1.2; p = 0.01). In summary, we found that PPA non-adherence occurred in a substantial minority of patients and was more likely in patients with known NMOU risk factors. These findings underscore the potential role of universal PPAs and systematic screening of NMOU risk factors to streamline care.

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Objective To estimate the prevalence and risk factors for falls requiring medical attention, referred as medical falls, in community-dwelling persons aged ≥60 years.Methods A cross-sectional analysis was conducted using information from the Health, Well-Being, and Aging (“SABE”) Study in Latin America and the Caribbean (7 cities), as well as from the SABE Bogota study (pooled sample of 8 cities n=12,487). Falls that occurred during a past 12-month period were considered and then noted if required medical treatment because of the fall.Results The weighted prevalence of medical falls across the eight surveys ranged from 6.0% to 11.3%. In weighted multivariate logistic regression analyses, potentially modifiable risk factors for medical falls include urinary incontinence (OR=1.51 95% CI 1.18-1.92), high depressive symptomatology (OR=1.53 95% CI 1.24-1.91), poor self-rated health (OR=1.35 95% CI 1.10-1.66) and activities of daily living limitations (OR=1.48 95% CI 1.16-1.87).Conclusions Based on our results, preventive measures targeting these risk factors may help to decrease the risk for medical falls among older adults in Latin America.

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