Decreasing Trends in Opioid Prescribing on Discharge to Hospice Care
There are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life. We assessed trends in opioid prescribing among patients on discharge from the hospital to hospice care. This was a retrospective cohort study among adult (age ≥18...
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| Vydáno v: | Journal of pain and symptom management Ročník 62; číslo 5; s. 1026 - 1033 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
Elsevier Inc
01.11.2021
Elsevier Limited |
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| ISSN: | 0885-3924, 1873-6513, 1873-6513 |
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| Abstract | There are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life.
We assessed trends in opioid prescribing among patients on discharge from the hospital to hospice care.
This was a retrospective cohort study among adult (age ≥18 years) patients discharged from a 544-576 bed, academic medical center to hospice care between January 1, 2010 to December 31, 2018. Study data were collected from a repository of patients’ electronic health record data. Our primary outcome was the frequency of opioid prescribing on discharge to hospice care. Our primary exposure was the calendar year of discharge. We also investigated non-opioid analgesic prescribing and stratified opioid prescribing trends by patient characteristics (e.g., demographics, cancer diagnosis, and location of hospice care).
Among 2,648 discharges to hospice care, mean (standard deviation) age was 65.8 (16.0) years, 46.3% were female, and 58.7% had a cancer diagnosis. Opioid prescribing on discharge to hospice care decreased significantly from 91.2% (95% confidence interval (CI) = 87.1%–94.1%) in 2010 to 79.3% (95% CI = 74.3%–83.5%) in 2018 adjusting for age, sex, cancer diagnosis, and location of hospice care. Prescribing of non-opioid analgesic medications increased over the same time period.
We observed a statistically significant decreasing trend in opioid prescribing on discharge to hospice care. Further research should aim to confirm these findings and to identify opportunities to ensure optimal pain management among patients transitioning to hospice care. |
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| AbstractList | AbstractContextThere are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life. ObjectiveWe assessed trends in opioid prescribing among patients on discharge from the hospital to hospice care. MethodsThis was a retrospective cohort study among adult (age ≥18 years) patients discharged from a 544-576 bed, academic medical center to hospice care between January 1, 2010 to December 31, 2018. Study data were collected from a repository of patients’ electronic health record data. Our primary outcome was the frequency of opioid prescribing on discharge to hospice care. Our primary exposure was the calendar year of discharge. We also investigated non-opioid analgesic prescribing and stratified opioid prescribing trends by patient characteristics (e.g., demographics, cancer diagnosis, and location of hospice care). ResultsAmong 2,648 discharges to hospice care, mean (standard deviation) age was 65.8 (16.0) years, 46.3% were female, and 58.7% had a cancer diagnosis. Opioid prescribing on discharge to hospice care decreased significantly from 91.2% (95% confidence interval (CI) = 87.1%–94.1%) in 2010 to 79.3% (95% CI = 74.3%–83.5%) in 2018 adjusting for age, sex, cancer diagnosis, and location of hospice care. Prescribing of non-opioid analgesic medications increased over the same time period. ConclusionsWe observed a statistically significant decreasing trend in opioid prescribing on discharge to hospice care. Further research should aim to confirm these findings and to identify opportunities to ensure optimal pain management among patients transitioning to hospice care. There are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life. We assessed trends in opioid prescribing among patients on discharge from the hospital to hospice care. This was a retrospective cohort study among adult (age ≥18 years) patients discharged from a 544-576 bed, academic medical center to hospice care between January 1, 2010 to December 31, 2018. Study data were collected from a repository of patients' electronic health record data. Our primary outcome was the frequency of opioid prescribing on discharge to hospice care. Our primary exposure was the calendar year of discharge. We also investigated non-opioid analgesic prescribing and stratified opioid prescribing trends by patient characteristics (e.g., demographics, cancer diagnosis, and location of hospice care). Among 2,648 discharges to hospice care, mean (standard deviation) age was 65.8 (16.0) years, 46.3% were female, and 58.7% had a cancer diagnosis. Opioid prescribing on discharge to hospice care decreased significantly from 91.2% (95% confidence interval (CI) = 87.1%-94.1%) in 2010 to 79.3% (95% CI = 74.3%-83.5%) in 2018 adjusting for age, sex, cancer diagnosis, and location of hospice care. Prescribing of non-opioid analgesic medications increased over the same time period. We observed a statistically significant decreasing trend in opioid prescribing on discharge to hospice care. Further research should aim to confirm these findings and to identify opportunities to ensure optimal pain management among patients transitioning to hospice care. There are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life.CONTEXTThere are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life.We assessed trends in opioid prescribing among patients on discharge from the hospital to hospice care.OBJECTIVEWe assessed trends in opioid prescribing among patients on discharge from the hospital to hospice care.This was a retrospective cohort study among adult (age ≥18 years) patients discharged from a 544-576 bed, academic medical center to hospice care between January 1, 2010 to December 31, 2018. Study data were collected from a repository of patients' electronic health record data. Our primary outcome was the frequency of opioid prescribing on discharge to hospice care. Our primary exposure was the calendar year of discharge. We also investigated non-opioid analgesic prescribing and stratified opioid prescribing trends by patient characteristics (e.g., demographics, cancer diagnosis, and location of hospice care).METHODSThis was a retrospective cohort study among adult (age ≥18 years) patients discharged from a 544-576 bed, academic medical center to hospice care between January 1, 2010 to December 31, 2018. Study data were collected from a repository of patients' electronic health record data. Our primary outcome was the frequency of opioid prescribing on discharge to hospice care. Our primary exposure was the calendar year of discharge. We also investigated non-opioid analgesic prescribing and stratified opioid prescribing trends by patient characteristics (e.g., demographics, cancer diagnosis, and location of hospice care).Among 2,648 discharges to hospice care, mean (standard deviation) age was 65.8 (16.0) years, 46.3% were female, and 58.7% had a cancer diagnosis. Opioid prescribing on discharge to hospice care decreased significantly from 91.2% (95% confidence interval (CI) = 87.1%-94.1%) in 2010 to 79.3% (95% CI = 74.3%-83.5%) in 2018 adjusting for age, sex, cancer diagnosis, and location of hospice care. Prescribing of non-opioid analgesic medications increased over the same time period.RESULTSAmong 2,648 discharges to hospice care, mean (standard deviation) age was 65.8 (16.0) years, 46.3% were female, and 58.7% had a cancer diagnosis. Opioid prescribing on discharge to hospice care decreased significantly from 91.2% (95% confidence interval (CI) = 87.1%-94.1%) in 2010 to 79.3% (95% CI = 74.3%-83.5%) in 2018 adjusting for age, sex, cancer diagnosis, and location of hospice care. Prescribing of non-opioid analgesic medications increased over the same time period.We observed a statistically significant decreasing trend in opioid prescribing on discharge to hospice care. Further research should aim to confirm these findings and to identify opportunities to ensure optimal pain management among patients transitioning to hospice care.CONCLUSIONSWe observed a statistically significant decreasing trend in opioid prescribing on discharge to hospice care. Further research should aim to confirm these findings and to identify opportunities to ensure optimal pain management among patients transitioning to hospice care. Context There are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life. Objective We assessed trends in opioid prescribing among patients on discharge from the hospital to hospice care. Methods This was a retrospective cohort study among adult (age ≥18 years) patients discharged from a 544-576 bed, academic medical center to hospice care between January 1, 2010 to December 31, 2018. Study data were collected from a repository of patients' electronic health record data. Our primary outcome was the frequency of opioid prescribing on discharge to hospice care. Our primary exposure was the calendar year of discharge. We also investigated non-opioid analgesic prescribing and stratified opioid prescribing trends by patient characteristics (e.g., demographics, cancer diagnosis, and location of hospice care). Results Among 2,648 discharges to hospice care, mean (standard deviation) age was 65.8 (16.0) years, 46.3% were female, and 58.7% had a cancer diagnosis. Opioid prescribing on discharge to hospice care decreased significantly from 91.2% (95% confidence interval (CI) = 87.1%–94.1%) in 2010 to 79.3% (95% CI = 74.3%–83.5%) in 2018 adjusting for age, sex, cancer diagnosis, and location of hospice care. Prescribing of non-opioid analgesic medications increased over the same time period. Conclusions We observed a statistically significant decreasing trend in opioid prescribing on discharge to hospice care. Further research should aim to confirm these findings and to identify opportunities to ensure optimal pain management among patients transitioning to hospice care. |
| Author | Teno, Joan M. Fromme, Erik K. Noble, Brie N. Hartung, Daniel M. Lynn, Mary Tjia, Jennifer Furuno, Jon P. |
| AuthorAffiliation | 6 Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR 3 Ariadne Labs at Brigham and Women’s Hospital and the Harvard T. H. Chan School of Public Health, Boston, MA 5 Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD 2 Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA 1 Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, OR 4 Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA |
| AuthorAffiliation_xml | – name: 1 Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, OR – name: 3 Ariadne Labs at Brigham and Women’s Hospital and the Harvard T. H. Chan School of Public Health, Boston, MA – name: 4 Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA – name: 5 Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD – name: 6 Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR – name: 2 Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA |
| Author_xml | – sequence: 1 givenname: Jon P. surname: Furuno fullname: Furuno, Jon P. email: furuno@ohsu.edu organization: Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA – sequence: 2 givenname: Brie N. surname: Noble fullname: Noble, Brie N. organization: Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA – sequence: 3 givenname: Erik K. surname: Fromme fullname: Fromme, Erik K. organization: Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA – sequence: 4 givenname: Daniel M. surname: Hartung fullname: Hartung, Daniel M. organization: Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA – sequence: 5 givenname: Jennifer surname: Tjia fullname: Tjia, Jennifer organization: Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA – sequence: 6 givenname: Mary surname: Lynn fullname: Lynn, Mary organization: Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA – sequence: 7 givenname: Joan M. surname: Teno fullname: Teno, Joan M. organization: Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA |
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| Keywords | transitions of care pain management Hospice care opioids |
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| Snippet | There are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life.
We assessed trends in... AbstractContextThere are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life.... Context There are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life. Objective We... There are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life.CONTEXTThere are... |
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| SubjectTerms | Adolescent Adult Age Age groups Aged Analgesics Analgesics, Opioid - therapeutic use Anesthesia Cancer Cohort analysis Demography Discharge End of life decisions Female Hospice Care Humans Medical diagnosis Medical records Narcotics Opioids Pain pain management Pain Medicine Patient Discharge Patients Practice Patterns, Physicians Prescribing Retrospective Studies transitions of care Trends |
| Title | Decreasing Trends in Opioid Prescribing on Discharge to Hospice Care |
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