Emergency department provider and facility variation in opioid prescriptions for discharged patients

Ward, Michael J.; Kc, Diwas Singh; Jenkins, Cathy A.; Liu, Dandan; Padaki, Amit; Pines, Jesse M.

doi:10.1016/j.ajem.2018.07.054

Cited by 17 publications

(10 citation statements)

References 36 publications

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“…In particular, our study found age over 43.84-years to be an independent risk factor for opioid prescriptions in non-emergent LBP patients. However, the direct relationship between age and ED opioid prescriptions found in our study has not been demonstrated for all chief complaints presenting to the ED For instance, Ward et al [ 24 ] utilized the Data to Intelligence database aggregating electronic health record data from EDs within the United States from January 1, 2014 to May 31, 2014, and found no direct relationship between increasing age and opioid prescription. In their study, patients between the ages of 18 to 27 had the highest adjusted odds ratio (OR: 1.09) of being discharged with an opioid prescription, followed by patients between the ages of 40 to 54 (OR: 1.08), and lastly between the ages of 28 to 39 (OR: 1.02)[ 24 ].…”

Section: Discussioncontrasting

confidence: 76%

“…However, the direct relationship between age and ED opioid prescriptions found in our study has not been demonstrated for all chief complaints presenting to the ED For instance, Ward et al [ 24 ] utilized the Data to Intelligence database aggregating electronic health record data from EDs within the United States from January 1, 2014 to May 31, 2014, and found no direct relationship between increasing age and opioid prescription. In their study, patients between the ages of 18 to 27 had the highest adjusted odds ratio (OR: 1.09) of being discharged with an opioid prescription, followed by patients between the ages of 40 to 54 (OR: 1.08), and lastly between the ages of 28 to 39 (OR: 1.02)[ 24 ]. Ward et al [ 24 ] studied all ED admissions, not limited to back pain, and attempted to account for variations in chief complaints utilization a categorization approach, however, the authors acknowledged remaining heterogeneity in terms of the chief complaints in their dataset.…”

Section: Discussioncontrasting

confidence: 76%

“…In their study, patients between the ages of 18 to 27 had the highest adjusted odds ratio (OR: 1.09) of being discharged with an opioid prescription, followed by patients between the ages of 40 to 54 (OR: 1.08), and lastly between the ages of 28 to 39 (OR: 1.02)[ 24 ]. Ward et al [ 24 ] studied all ED admissions, not limited to back pain, and attempted to account for variations in chief complaints utilization a categorization approach, however, the authors acknowledged remaining heterogeneity in terms of the chief complaints in their dataset. In comparison, our study only included patients presenting with non-emergent LBP, such that the chief complaints were entirely homogenous, which contributed to the direct correlation we found between age and ED opioid prescriptions in non-emergent LBP patients.…”

Section: Discussionmentioning

confidence: 99%

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Trends and risk factors for opioid administration for non-emergent lower back pain

Gwam¹,

Chughtai²,

Javed³

et al. 2021

WJO

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BACKGROUND Non-emergent low-back pain (LBP) is one of the most prevalent presenting complaints to the emergency department (ED) and has been shown to contribute to overcrowding in the ED as well as diverting attention away from more serious complaints. There has been an increasing focus in current literature regarding ED admission and opioid prescriptions for general complaints of pain, however, there is limited data concerning the trends over the last decade in ED admissions for non-emergent LBP as well as any subsequent opioid prescriptions by the ED for this complaint. AIM To determine trends in non-emergent ED visits for back pain; annual trends in opioid administration for patients presenting to the ED for back pain; and factors associated with receiving an opioid-based medication for non-emergent LBP in the ED METHODS Patients presenting to the ED for non-emergent LBP from 2010 to 2017 were retrospectively identified from the National Hospital Ambulatory Medical Care Survey database. The “year” variable was transformed to two-year intervals, and a weighted survey analysis was conducted utilizing the weighted variables to generate incidence estimates. Bivariate statistics were used to assess differences in count data, and logistic regression was performed to identify factors associated with patients being discharged from the ED with narcotics. Statistical significance was set to a P value of 0.05. RESULTS Out of a total of 41658475 total ED visits, 3.8% (7726) met our inclusion and exclusion criteria. There was a decrease in the rates of non-emergent back pain to the ED from 4.05% of all cases during 2010 and 2011 to 3.56% during 2016 and 2017. The most common opioids prescribed over the period included hydrocodone-based medications (49.1%) and tramadol-based medications (16.9), with the combination of all other opioid types contributing to 35.7% of total opioids prescribed . Factors significantly associated with being prescribed narcotics included age over 43.84-years-old, higher income, private insurance, the obtainment of radiographic imaging in the ED, and region of the United States (all, P < 0.05). Emergency departments located in the Midwest [odds ratio (OR): 2.42, P < 0.001], South (OR: 2.35, < 0.001), and West (OR: 2.57, P < 0.001) were more likely to prescribe opioid-based medications for non-emergent LBP compared to EDs in the Northeast. CONCLUSION From 2010 to 2017, there was a significant decrease in the number of non-emergent LBP ED visits, as well as a decrease in opioids prescribed at these visits. These findings may be attributed to the increased focus and regulatory guidelines on opioid prescription practices at both the federal and state levels. Since non-emergent LBP is still a highly common ED presentation, conclusions drawn...

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Section: Discussioncontrasting

confidence: 76%

Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trends and risk factors for opioid administration for non-emergent lower back pain

Gwam¹,

Chughtai²,

Javed³

et al. 2021

WJO

View full text Add to dashboard Cite

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“…Studies have found that opioid prescription rates are dependent on the facility, physician, geographic location, and situational or workload factors. [10][11][12][13] Other more implicit factors that have been identified may include a patient's age, race, ethnicity, socioeconomic status, gender, insurance, clinical presentation, and physician's judgment as to whether a patient may display drug-seeking behaviors. [14][15][16][17][18][19] Physicians are often wary of prescribing opioids to patients who have a history of drug abuse or are taking illicit drugs that may cause an accidental overdose.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

Positive Toxicology Results Are Not Associated with Emergency Physicians’ Opioid Prescribing Behavior

Lee

Ghanem

Saadat

et al. 2021

WestJEM

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Introduction: Given the general lack of literature on opioid and naloxone prescribing guidelines for patients with substance use disorder, we aimed to explore how a physician’s behavior and prescribing habits are altered by knowledge of the patient’s concomitant use of psychotropic compounds as evident on urine and serum toxicology screens. Methods: We conducted a retrospective chart review study at a tertiary, academic, Level I trauma center between November 2017–October 2018 that included 358 patients who were discharged from the emergency department (ED) with a diagnosis of fracture, dislocation, or amputation and received an opioid prescription upon discharge. We extracted urine and serum toxicology results, number and amount of prescription opioids upon discharge, and the presence of a naloxone script. Results: The study population was divided into five subgroups that included the following: negative urine and serum toxicology screen; depressants; stimulants; mixed; and no toxicology screens. When comparing the 103 patients in which toxicology screens were obtained to the 255 patients without toxicology screens, we found no statistically significant differences in the total prescribed morphine milligram equivalent (75.0 and 75.0, respectively) or in the number of pills prescribed (15.0 and 13.5, respectively). Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge. Conclusion: Our study found no association between positive urine toxicology results for psychotropically active substances and the rates of opioid prescribing within a single-center, academic ED. Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge. More research on the associations between illicit drug use, opioids, and naloxone prescriptions is necessary to help establish guidelines for high-risk patients.

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“…Another found that 42% of ED patients discharged with a prescription opioid analgesic reported using them inappropriately within 30 days [3]. Variations in opioid analgesic prescribing at ED discharge across institutions [4][5][6][7] and individual physicians [1,8,9] have been raised as potential intervention areas.…”

Section: Introductionmentioning

confidence: 99%

Variation in opioid analgesia administration and discharge prescribing for emergency department patients with suspected urolithiasis

Wentz

Wang

Marshall

et al. 2020

The American Journal of Emergency Medicine

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OBJECTIVE.-Previous research has suggested caution about opioid analgesic usage in the emergency department (ED) setting and raised concerns about variations in prescription opioid analgesic usage, both across institutions and for whom they are prescribed. We examined opioid analgesic usage in ED patients with suspected urolithiasis across fifteen participating hospitals.METHODS.-This secondary analysis of a clinical trial including adult ED patients with suspected urolithiasis. In multilevel models accounting for clustering by hospital, we assessed demographic, clinical, state-level, and hospital-level factors associated with opioid analgesic administration during the ED visit and prescription at discharge.

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Emergency department provider and facility variation in opioid prescriptions for discharged patients

Cited by 17 publications

References 36 publications

Trends and risk factors for opioid administration for non-emergent lower back pain

Trends and risk factors for opioid administration for non-emergent lower back pain

Positive Toxicology Results Are Not Associated with Emergency Physicians’ Opioid Prescribing Behavior

Variation in opioid analgesia administration and discharge prescribing for emergency department patients with suspected urolithiasis

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