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Opioid Prescribing Following Opioid-Related Inpatient Hospitalizations by Diagnosis: A Cohort Study
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10 2019
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Source: Med Care. 57(10):815-821
[PDF-1022.46 KB]
Details:
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Alternative Title:Med Care
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Personal Author:
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Description:Background:
Any opioid-related hospitalization is an indicator of opioid-related harm and should ideally trigger carefully monitored decreases in opioid prescribing following inpatient stays in many, if not most, cases. However, past studies on opioid prescribing following hospitalizations have largely been limited to overdose related visits. It is unclear whether prescribing is different for other opioid related indications such as opioid dependence and abuse and how that may compare to hospitalizations for overdose.
Objective:
To examine opioid-prescribing patterns before and after opioid-related hospitalizations for all opioid-related indications, not limited to overdose.
Research Design:
Retrospective cohort analysis of Veterans Health Administration (VHA) administrative claims from 2011-2014.
Subjects:
VHA patients who were hospitalized between fiscal years 2011-2014 and had at least one prescription opioid medication filled through the VHA pharmacy prior to their hospitalization.
Measures:
Opioid dispensing trajectories after hospitalization by opioid-related indication (i.e., opioid dependence and/or abuse versus overdose) compared to prescribing patterns for non-opioid-related hospitalizations.
Results:
Overall, opioid dosage dropped significantly (66% for dependence/abuse, 42% for overdose, and 3% for non-opioid diagnoses, p<0.001) across all three categories when comparing dose 57-63 days following admission to 57-63 days prior to hospitalization. However, 47% of patients remained on the same dose or increased their opioid dose at 60 days following an opioid-related hospitalization. After adjusting for covariates, patients with a primary diagnosis of dependence/abuse had higher odds of having their dose discontinued compared to those with overdose: OR 2.17 (1.19-3.96). Patients with admissions for opioid dependence and/or abuse had a statistically significant higher prevalence of depression, post-traumatic stress disorder, anxiety and substance use disorders compared to those with an opioid overdose hospitalization.
Conclusions:
Opioid prescribing and patient risk factors before and after opioid-related hospitalizations vary by indication for hospitalization. To reduce costs and morbidity associated with opioid-related hospitalizations, opioid de-intensification efforts need to be tailored to indication for hospitalization.
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Source:
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Pubmed ID:31415341
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Pubmed Central ID:PMC6742521
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Document Type:
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Funding:
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Volume:57
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Issue:10
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