State Regulation Positively Impacts Opioid Prescribing Patterns in Ankle Fracture Surgery: A National and State-Level Analysis

Injury ◽  
2021 ◽  
Author(s):  
Daniel J. Cunningham ◽  
Michael Blatter ◽  
Samuel B. Adams ◽  
Mark J. Gage
Keyword(s):  
Ankle Fracture ◽  
State Level ◽  
State Regulation ◽  
Prescribing Patterns ◽  
Opioid Prescribing ◽  
Fracture Surgery ◽  
Level Analysis

scholarly journals Temporal Trends in Opioid Prescribing Patterns Among Oncologists in the Medicare Population

2020 ◽  
Author(s):  
Vikram Jairam ◽  
Daniel X Yang ◽  
Saamir Pasha ◽  
Pamela R Soulos ◽  
Cary P Gross ◽  
...  
Keyword(s):  
Negative Binomial ◽  
Temporal Trends ◽  
State Level ◽  
Negative Binomial Regression ◽  
Time Frame ◽  
Prescribing Patterns ◽  
Annual Number ◽  
Medicare Beneficiaries ◽  
Care Providers ◽  
Opioid Prescribing

Abstract Background In the wake of the US opioid epidemic, there have been efforts to curb opioid prescribing. However, it is unknown whether these efforts have affected prescribing among oncologists, whose patients often require opioids for symptom management. We investigated temporal patterns in opioid prescribing for Medicare beneficiaries among oncologists and nononcologists. Methods We queried the Centers for Medicare and Medicaid Services Part D prescriber dataset for all physicians between January 1, 2013, and December 31, 2017. We used population-averaged multivariable negative binomial regression to estimate the association between time and per-provider opioid and gabapentinoid prescribing rate, defined as the annual number of drug claims (original prescriptions and refills) per beneficiary, among oncologists and nononcologists on a national and state level. Results From 2013 to 2017, the national opioid-prescribing rate declined by 20.7% (P < .001) among oncologists and 22.8% (P < .001) among non oncologists. During this time frame, prescribing of gabapentin increased by 5.9% (P < .001) and 23.1% (P < .001) among oncologists and nononcologists, respectively. Among palliative care providers, opioid prescribe increased by 15.3% (P < .001). During the 5-year period, 43 states experienced a decrease (P < .05) in opioid prescribing among oncologists, and in 5 states, opioid prescribing decreased more among oncologists than nononcologists (P < .05). Conclusions Between 2013 and 2017, the opioid-prescribing rate statistically significantly decreased nationwide among oncologists and nononcologists, respectively. Given similar declines in opioid prescribing among oncologists and nononcologists, there is concern that opioid-prescribing guidelines intended for the noncancer population are being applied inappropriately to patients with cancer and cancer survivors.

The Politics of Chiefs and Commoners before the 1830s

2020 ◽  
Author(s):  
Raevin Jimenez
Keyword(s):  
Nineteenth Century ◽  
South African ◽  
State Level ◽  
Temporal Context ◽  
Political Elites ◽  
African History ◽  
New Wave ◽  
Early Nineteenth Century ◽  
Late Eighteenth ◽  
Level Analysis

The field of pre-1830 South African history has been subject to periodic interrogations into conventional narratives, sources, and methods. The so-called mfecane debates of the 1980s and 1990s marked a radical departure from characterizations of warfare in the interior, generally regarded in earlier decades as stemming solely or mostly from the Zulu king Shaka. Efforts to reframe violence led to more thorough considerations of political elites and statecraft from the late eighteenth to the early nineteenth century but also contributed to new approaches to ethnicity, dependency, and to some extent gender. A new wave of historiographical critique in the 2010s shows the work of revision to be ongoing. The article considers the debates around the wars of the late precolonial period, including unresolved strands of inquiry, and argues for a move away from state-level analysis toward social histories of women and non-elites. Though it focuses on the 1760s through the 1830s, the article also presents examples highlighting the importance of recovering deeper temporal context for the South African interior.

Opioid Consumption Patterns and Prolonged Opioid Use Among Opioid-Naïve Ankle Fracture Patients

2021 ◽  
pp. 193864002199292
Author(s):  
Hope Skibicki ◽  
Sundeep Saini ◽  
Ryan Rogero ◽  
Kristen Nicholson ◽  
Rachel J. Shakked ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Monitoring Program ◽  
Opioid Consumption ◽  
Consumption Patterns ◽  
Utilization Rate ◽  
Opioid Use ◽  
Index Procedure ◽  
Postoperative Visit ◽  
Fracture Surgery

Introduction Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Here, the investigators assess immediate postoperative opioid consumption patterns as well as the incidence of prolonged opioid use among opioid-naïve patients following ankle fracture surgery. Methods Included patients underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture over a 1-year period. At patients’ first postoperative visit, opioid pills were counted and standardized to the equivalent number of 5-mg oxycodone pills. Prolonged use was defined as filling a prescription for a controlled substance more than 90 days after the index procedure, tracked by the New Jersey Prescription Drug Monitoring Program up to 1 year postoperatively. Results At the first postoperative visit, 173 patients consumed a median of 24 out of 40 pills prescribed. The initial utilization rate was 60%, and 2736 pills were left unused. In all, 32 (18.7%) patients required a narcotic prescription 90 days after the index procedure. Patients with a self-reported history of depression (P = .11) or diabetes (P = .07) demonstrated marginal correlation with prolonged narcotic use. Conclusion Our study demonstrated that, on average, patients utilize significantly fewer opioid pills than prescribed and that many patient demographics are not significant predictors of continued long-term use following outpatient ankle fracture surgery. Large variations in consumption rates make it difficult for physicians to accurately prescribe and predict prolonged narcotic use. Level of Evidence: Level III

Variation in opioid prescribing patterns after abdominal transplant surgery

2021 ◽  
Author(s):  
Jon Sussman ◽  
Esteban Calderon ◽  
Daniel S. Ubl ◽  
Kristopher Croome ◽  
C. Burcin Taner ◽  
...  
Keyword(s):  
Prescribing Patterns ◽  
Opioid Prescribing

scholarly journals Opioid Prescribing to Medicare Part D Enrollees, 2013–2017: Shifting Responsibility to Pain Management Providers

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1400-1407 ◽  
Author(s):  
Adam N Romman ◽  
Connie M Hsu ◽  
Lin-Na Chou ◽  
Yong-Fang Kuo ◽  
Rene Przkora ◽  
...  
Keyword(s):  
Pain Management ◽  
Medicare Part D ◽  
Medical Specialty ◽  
Medicare Part ◽  
Provider Type ◽  
Cross Sectional ◽  
Part D ◽  
Opioid Prescribing ◽  
Prescribing Trends ◽  
Level Analysis

Abstract Objective To examine opioid prescribing frequency and trends to Medicare Part D enrollees from 2013 to 2017 by medical specialty and provider type. Methods We conducted a retrospective, cross-sectional, specialty- and provider-level analysis of Medicare Part D prescriber data for opioid claims from 2013 to 2017. We analyzed opioid claims and prescribing trends for specialties accounting for ≥1% of all opioid claims. Results From 2013 to 2017, pain management providers increased Medicare Part D opioid claims by 27.3% to 1,140 mean claims per provider in 2017; physical medicine and rehabilitation providers increased opioid claims 16.9% to 511 mean claims per provider in 2017. Every other medical specialty decreased opioid claims over this period, with emergency medicine (–19.9%) and orthopedic surgery (–16.0%) dropping opioid claims more than any specialty. Physicians overall decreased opioid claims per provider by –5.2%. Meanwhile, opioid claims among both dentists (+5.6%) and nonphysician providers (+10.2%) increased during this period. Conclusions From 2013 to 2017, pain management and PMR increased opioid claims to Medicare Part D enrollees, whereas physicians in every other specialty decreased opioid prescribing. Dentists and nonphysician providers also increased opioid prescribing. Overall, opioid claims to Medicare Part D enrollees decreased and continue to drop at faster rates.

scholarly journals Surgeon-Volume Comparison of Opioid Prescribing Patterns to Adolescents After Outpatient Arthroscopy

2021 ◽  
Vol 37 (1) ◽  
pp. e78-e79
Author(s):  
Tyler A. Luthringer ◽  
David A. Bloom ◽  
Kirsten Schardt ◽  
Nicholas Meglino ◽  
Lorraine Hultzer ◽  
...  
Keyword(s):  
Surgeon Volume ◽  
Prescribing Patterns ◽  
Volume Comparison ◽  
Opioid Prescribing
Sign in / Sign up

Export Citation Format

Share Document