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
Hlavní autoři: Furuno, Jon P., Noble, Brie N., Fromme, Erik K., Hartung, Daniel M., Tjia, Jennifer, Lynn, Mary, Teno, Joan M.
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Elsevier Inc 01.11.2021
Elsevier Limited
Témata:
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
transitions of care
pain management
Hospice care
opioids
ISSN:0885-3924, 1873-6513, 1873-6513
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Shrnutí: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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Author Roles and Responsibilities: Study concept and design (JPF, BNN, EKF, JMT), acquisition of data (JPF, BNN), analysis of the data, (JPF, BNN), interpretation of results (all authors), preparation of the initial draft of the manuscript (JPF, BNN, JT) and critical review of the manuscript (all authors).
ISSN:0885-3924
1873-6513
1873-6513
DOI:10.1016/j.jpainsymman.2021.03.025