scholarly journals 3377 A cross-sectional analysis of opioid prescribing patterns among gynecologic oncologists using Medicare fee-for service provider utilization & payment data

2019 ◽  
Vol 3 (s1) ◽  
pp. 31-31
Author(s):  
David Samuel ◽  
Devin Miller ◽  
Sara Isani ◽  
Dennis Kuo ◽  
Gregory Gressel
Keyword(s):  
National Level ◽  
Adverse Outcomes ◽  
Prescribing Patterns ◽  
Fee For Service ◽  
Years Of Experience ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Exact Test ◽  
Opioid Prescribing ◽  
National Medical

OBJECTIVES/SPECIFIC AIMS: Opioids are the first-line treatment for moderate to severe cancer-related pain. Increased awareness of opioid prescription misuse and adverse outcomes has prompted statements on their use from multiple national medical groups. In this study we characterize national-level opioid prescription patterns among gynecologic oncologists treating Medicare beneficiaries. METHODS/STUDY POPULATION: The Centers for Medicare and Medicaid Services (CMS) database was used to access Medicare Part D beneficiary data (2016). All available opioid claims prescribed by gynecologic oncologists were identified. Medication type, prescription length and other prescribing factors were recorded. Physician demographics were obtained from departmental websites and accrediting bodies. Physicians with <10 opioid claims are not included in the CMS database. Bivariate statistical analysis including chi-squared, Fisher’s exact test and Wilcoxon rank-sum test were performed to compare variables with threshold for significance set at p<0.05. Linear regression modeling was also performed to examine association of gender with number of opioids prescribed. RESULTS/ANTICIPATED RESULTS: A total of 494 board-certified gynecologic oncologists were included in this analysis. In 2016, gynecologic oncologists wrote 23,584 opioid prescriptions for 267,824 days of treatment (average of 9.24 prescribed days per claim). The most commonly prescribed opioid was oxycodone/acetaminophen (41%). Male physicians had significantly more opioid prescription claims than females (p<0.01) including after adjusting for differences in years of experience. The majority of physicians had 11-50 opioid prescription claims (68%). A minority were high prescribing physicians with >100 opioid claims (11%). Of these, the overwhelming majority were male (82%) and late career (46%, >15 years since board certification). Physicians in the South had the greatest number of opioid prescription claims and significantly more than physicians in the Northeast, who had the fewest (p<0.01). Mean number of opioid claims increased with increasing years of experience (p<0.05). DISCUSSION/SIGNIFICANCE OF IMPACT: Among gynecologic oncologists, there were gender-based, regional and experience-related variations in opioid prescribing in the Medicare population in 2016. Further longitudinal studies are required to elucidate secular trends in opioid prescription practice.

Current Opioid Prescribing Patterns after Microdirect Laryngoscopy

2019 ◽  
Vol 129 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Molly N. Huston ◽  
Rouya Kamizi ◽  
Tanya K. Meyer ◽  
Albert L. Merati ◽  
John Paul Giliberto
Keyword(s):  
The United States ◽  
Opioid Abuse ◽  
Prescribing Patterns ◽  
Opioid Analgesia ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Opioid Prescribing

Background: The prevalence of opioid abuse has become epidemic in the United States. Microdirect laryngoscopy (MDL) is a common otolaryngological procedure, yet prescribing practices for opioids following this operation are not well characterized. Objective: To characterize current opioid-prescribing patterns among otolaryngologists performing MDL. Methods: A cross-sectional survey of otolaryngologists at a national laryngology meeting. Results: Fifty-eight of 205 physician registrants (response rate 28%) completed the survey. Fifty-nine percent of respondents were fellowship-trained in laryngology. Respondents performed an average of 13.3 MDLs per month. Thirty-four percent of surgeons prescribe opioids for over two-thirds of their MDLs, while only 7% of surgeons never prescribe opioids. Eighty-eight percent of surgeons prescribed a combination opioid and acetaminophen compound, hydrocodone being the most common opioid component. Many surgeons prescribe non-opioid analgesics as well, with 70% and 84% of surgeons recommending acetaminophen and ibuprofen after MDL respectively. When opioids were prescribed, patient preference, difficult exposure and history of opioid use were the most influential patient factors. Concerns of opioid abuse, the physician role in the opioid crisis, and literature about postoperative non-opioid analgesia were also underlying themes in influencing opioid prescription patterns after MDL. Conclusions: In this study, over 90% of practicing physicians surveyed are prescribing opioids after MDL, though many are also prescribing non-opioid analgesia as well. Further studies should be completed to investigate the needs of patients following MDL in order to allow physicians to selectively and appropriately prescribe opioid analgesia postoperatively.

Opioids and the Otolaryngologist: An Ambulatory Assessment

2018 ◽  
Vol 159 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Suresh Mohan ◽  
Neil Bhattacharyya
Keyword(s):  
United States ◽  
Chronic Otitis Media ◽  
The United States ◽  
Prescribing Patterns ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Significant Difference ◽  
Care Survey ◽  
Ambulatory Medical Care

Objectives To recognize current opioid prescription patterns in otolaryngology and determine changes in rates of outpatient opioid prescribing over time. Study Design Cross-sectional analysis of national survey database. Setting Ambulatory care settings in the United States. Subjects and Methods The National Ambulatory Medical Care Survey from 2006 to 2013 was analyzed for outpatient otolaryngology visits. The rate of opioid medication prescribing was determined with patient and visit characteristics associated with an opioid prescription, including corresponding diagnoses. Calendar trends for the rate of opioid prescribing were determined and compared biennially. Results Among 19.2 ± 1.7 million otolaryngology visits annually (raw N = 11,905), there were 728,000 ± 96,000 visits with an opioid prescription (3.8% ± 0.4%). Adults were more likely than children to receive a narcotic (4.3% vs 1.9%, P < .001); there was no significant difference according to sex (3.9% female vs 3.7% male, P = .567). With respect to calendar trend, the opioid prescription rate increased significantly from 2.3% in 2006-2007 to 4.6% in 2008-2011 and then decreased to 3.5% in 2012-2013 ( P < .031). The most common visit diagnosis categories associated with opioid prescribing were as follows: postoperative care (19.7% of prescriptions), adenotonsillitis (13.9%), chronic otitis media (8.7%), otitis externa (6.2%), and nasal obstruction (5.6%). Conclusion Despite the opioid epidemic in the United States, only a small portion of otolaryngology visits were associated with opioid prescription. However, given the significant increase in prescribing from 2008 to 2011, continued surveillance of prescribing patterns is warranted.

scholarly journals Breathlessness and opioid prescribing in COPD in general practice: a cross-sectional, observational study

2020 ◽  
Vol 6 (2) ◽  
pp. 00299-2019
Author(s):  
David C. Currow ◽  
Miriam J. Johnson ◽  
Allan Pollack ◽  
Diana H. Ferreira ◽  
Slavica Kochovska ◽  
...  
Keyword(s):  
General Practice ◽  
Clinical Care ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Pain Patient ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Obstructive Pulmonary Disease ◽  
Health Database

Chronic breathlessness is a disabling syndrome, prevalent in people with advanced chronic obstructive pulmonary disease (COPD). Regular, low-dose, oral sustained-release morphine is approved in Australia to reduce symptomatic chronic breathlessness. We aimed to determine the current prescribing patterns of opioids for chronic breathlessness in COPD in Australian general practice and to define any associated patient and practitioner characteristics.Five years (2011 to 2016) of the Bettering the Evaluation and Care of Health database, an Australian national, continual, cross-sectional study of clinical care in general practice were used. The database included 100 consecutive clinical encounters from almost 1000 general practitioners annually (n=488 100 encounters). Descriptive analyses with subsequent regression models were generated.Breathlessness as a patient-defined reason for encounter was identified in 621 of 4522 encounters where COPD was managed. Opioids were prescribed in 309 of 4522 encounters where COPD was managed (6.8%; (95% CI) 6.1–7.6), of which only 17 were prescribed for breathlessness, and the rest for other conditions almost entirely related to pain. Patient age (45–64 years versus age 80+ years, OR 1.68; 1.19–2.36), Commonwealth Concession Card holders (OR 1.70; 1.23–2.34) and socioeconomic disadvantage (OR 1.30; 1.01–1.68) were associated with increased likelihood of opioid prescription at COPD encounters. The rate of opioid prescriptions rose over the 5 years of study.In primary care encounters for COPD, opioids were prescribed in 6.8% of cases, but almost never for breathlessness. These data create a baseline against which to compare changes in prescribing as the treatment of chronic breathlessness evolves.

scholarly journals Opioid Prescribing Patterns for Low Back Pain Among Commercially Insured Children

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tej D Azad ◽  
Michael D Harries ◽  
Daniel Vail ◽  
Yi Jonathan Zhang ◽  
John K Ratliff
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Prescribing Patterns ◽  
Low Back ◽  
Age Group ◽  
Newly Diagnosed ◽  
Opioid Prescription ◽  
Opioid Prescribing

Abstract INTRODUCTION Low back pain (LBP) may affect up to 20% of the pediatric population. No specific guidelines exist regarding pharmacotherapy for acute LBP in the pediatric population. Given this observation and the lack of data available regarding pharmacotherapy for pediatric LBP, we sought to characterize patterns of opioid prescribing in the pediatric population. METHODS We used a national database to identify pediatric patients (age 5-17) with newly diagnosed with LBP between 2008 and 2015 who did not have a red flag diagnosis, had not received an opioid prescription in the 6 mo prior to diagnosis, and had 12-mo of continuous enrollment after diagnosis. We used logistic regression to model the association between sex, geographic region, categorical age, and our primary outcome, receipt of an opioid prescription in the year following diagnosis. RESULTS Our sample included 268 228 opioid-naïve pediatric patients diagnosed with LBP between 2008 and 2015. We observed that 47 631 (17.8%) patients received physical therapy, 29 903 (11.2%) patients received chiropractic manipulative therapy, 658 (0.25%) patients received epidural steroid injection, and 281 (0.10%) patients received surgery. A total of 35 274 (13.2%) pediatric LBP patients were prescribed opioids within 12 mo from their diagnosis. Opioid prescribing decreased in all age groups over the study period age group 5 to 9 decreased from 4.2% to 2.7%, age group 10 to 14 decreased from 10.3% to 7.7%, and age group 15 to 18 yr decreased from 20.9% to 17.1%. Female pediatric patients were more likely than male patients to receive an opioid prescription (OR, 1.12, P < .0001). Patients ages 10 to 14 (OR, 2.89, P < .0001) and 15 to 18 (OR, 6.98, P < .0001) were significantly more likely to be prescribed opioids compared to patients in the youngest age group. CONCLUSION To our knowledge, we report the first observational cohort study of opioids and LBP in the pediatric population. Our findings indicate that opioids are being used for newly diagnosed LBP and receipt of opioids are associated with patient demographic factors.

scholarly journals Reduction in Hospital System Opioid Prescribing for Acute Pain Through Default Prescription Preference Settings: Pre–Post Study

10.2196/24360 ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. e24360
Author(s):  
Benjamin Heritier Slovis ◽  
Jeffrey M Riggio ◽  
Melanie Girondo ◽  
Cara Martino ◽  
Bracken Babula ◽  
...  
Keyword(s):  
The United States ◽  
Prescribing Patterns ◽  
Duration Of Treatment ◽  
Opioid Prescription ◽  
Hospital System ◽  
Opioid Prescribing ◽  
Before And After ◽  
Control And Prevention ◽  
Prescribing Practice ◽  
Quasi Experimental

Background The United States is in an opioid epidemic. Passive decision support in the electronic health record (EHR) through opioid prescription presets may aid in curbing opioid dependence. Objective The objective of this study is to determine whether modification of opioid prescribing presets in the EHR could change prescribing patterns for an entire hospital system. Methods We performed a quasi-experimental retrospective pre–post analysis of a 24-month period before and after modifications to our EHR’s opioid prescription presets to match Centers for Disease Control and Prevention guidelines. We included all opioid prescriptions prescribed at our institution for nonchronic pain. Our modifications to the EHR include (1) making duration of treatment for an opioid prescription mandatory, (2) adding a quick button for 3 days’ duration while removing others, and (3) setting the default quantity of all oral opioid formulations to 10 tablets. We examined the quantity in tablets, duration in days, and proportion of prescriptions greater than 90 morphine milligram equivalents/day for our hospital system, and compared these values before and after our intervention for effect. Results There were 78,246 prescriptions included in our study written on 30,975 unique patients. There was a significant reduction for all opioid prescriptions pre versus post in (1) the overall median quantity of tablets dispensed (54 [IQR 40-120] vs 42 [IQR 18-90]; P<.001), (2) median duration of treatment (10.5 days [IQR 5.0-30] vs 7.5 days [IQR 3.0-30]; P<.001), and (3) proportion of prescriptions greater than 90 morphine milligram equivalents/day (27.46% [10,704/38,976; 95% CI 27.02%-27.91%] vs 22.86% [8979/39,270; 95% CI 22.45%-23.28%]; P<.001). Conclusions Modifications of opioid prescribing presets in the EHR can improve prescribing practice patterns. Reducing duration and quantity of opioid prescriptions could reduce the risk of dependence and overdose.

scholarly journals Examining patterns in opioid prescribing for non-cancer-related pain in Wales: preliminary data from a retrospective cross-sectional study using large datasets

2018 ◽  
Vol 13 (3) ◽  
pp. 145-158 ◽  
Author(s):  
Emma Davies ◽  
Ceri Phillips ◽  
Jaynie Rance ◽  
Berni Sewell
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Large Scale ◽  
Study Cohort ◽  
Age Group ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Adult Age ◽  
Opioid Prescribing ◽  
Strong Opioid

Objectives: To examine trends in strong opioid prescribing in a primary care population in Wales and identify if factors such as age, deprivation and recorded diagnosis of depression or anxiety may have influenced any changes noted. Design: Trend, cross-sectional and longitudinal analyses of routine data from the Primary Care General Practice database and accessed via the Secure Anonymised Information Linkage (SAIL) databank. Setting: A total of 345 Primary Care practices in Wales. Participants: Anonymised records of 1,223,503 people aged 18 or over, receiving at least one opioid prescription between 1 January 2005 and 31 December 2015 were analysed. People with a cancer diagnosis (10.1%) were excluded from the detailed analysis. Results: During the study period, 26,180,200 opioid prescriptions were issued to 1,223,503 individuals (55.9% female, 89.9% non-cancer diagnoses). The greatest increase in annual prescribing was in the 18–24 age group (10,470%), from 0.08 to 8.3 prescriptions/1000 population, although the 85+ age group had the highest prescribing rates across the study period (from 149.9 to 288.5 prescriptions/1000 population). The number of people with recorded diagnoses of depression or anxiety and prescribed strong opioids increased from 1.2 to 5.1 people/1000 population (328%). The increase was 366.9% in areas of highest deprivation compared to 310.3 in the least. Areas of greatest deprivation had more than twice the rate of strong opioid prescribing than the least deprived areas of Wales. Conclusion: The study highlights a large increase in strong opioid prescribing for non-cancer pain, in Wales between 2005 and 2015. Population groups of interest include the youngest and oldest adult age groups and people with depression or anxiety particularly if living in the most deprived communities. Based on this evidence, development of a Welsh national guidance on safe and rational prescribing of opioids in chronic pain would be advisable to prevent further escalation of these medicines. Summary points This is the first large-scale, observational study of opioid prescribing in Wales. Over 1 million individual, anonymised medical records have been searched in order to develop the study cohort, thus reducing recall bias. Diagnosis and intervention coding in the Primary Care General Practice database is limited at input and may lead to under-reporting of diagnoses. There are limitations to the data available through the Secure Anonymised Information Linkage databank because anonymously linked dispensing data (what people collect from the pharmacy) are not currently available. Consequently, the results presented here could be seen as an ‘intention to treat’ and may under- or overestimate what people in Wales actually consume.

scholarly journals Creating opioid dependence in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 100-103 ◽  
Author(s):  
Suneel Upadhye
Keyword(s):  
Emergency Department ◽  
Opioid Dependence ◽  
Prescribing Patterns ◽  
Clinical Question ◽  
Emergency Physicians ◽  
Naive Patient ◽  
Opioid Prescription ◽  
Opioid Prescribing

Clinical questionWhat is the risk of creating opioid dependence from an ED opioid prescription?Article chosenBarnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med 2017;376:663-73, doi:10.1056/NEJMsa1610524.ObjectiveThis study examined the risk of creating long-term opioid dependence from a prescription written in an opioid-naive patient in the ED.

scholarly journals Trends in opioid prescribing practices in South Korea, 2009–2019: Are we safe from an opioid epidemic?

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250972
Author(s):  
Noo Ree Cho ◽  
Young Jin Chang ◽  
Dongchul Lee ◽  
Ji Ro Kim ◽  
Dai Sik Ko ◽  
...  
Keyword(s):  
South Korea ◽  
Extended Release ◽  
Population Based ◽  
Prescription Opioid ◽  
Prescribing Practices ◽  
Geographic Variations ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Long Acting

Opioid prescribing data can guide regulation policy by informing trends and types of opioids prescribed and geographic variations. In South Korea, the nationwide data on prescribing opioids remain unclear. We aimed to evaluate an 11-year trend of opioid prescription in South Korea, both nationally and by administrative districts. A population-based cross-sectional analysis of opioid prescriptions dispensed nationwide in outpatient departments between January 1, 2009, and December 31, 2019, was conducted for this study. Data were obtained from the Health Insurance Review & Assessment Service. The types of opioids prescribed were categorized into total, strong, and extended-release and long-acting formulation. Trends in the prescription rate per 1000 persons were examined over time nationally and across administrative districts. There are significant increasing trends for total, strong, and extended-release and long-acting opioid prescriptions (rate per 1000 persons in 2009 and 2019: total opioids, 347.5 and 531.3; strong opioids, 0.6 and 15.2; extended-release and long-acting opioids, 6.8 and 82.0). The pattern of dispensing opioids increased from 2009 to 2013 and slowed down from 2013 to 2019. The rate of opioid prescriptions issued between administrative districts nearly doubled for all types of opioids. Prescription opioid dispensing increased substantially over the study period. The increase in the prescription of total opioids was largely attributed to an increase in the prescription of weak opioids. However, the increase in prescriptions of extended-release and long-acting opioids could be a future concern. These data may inform government organizations to create regulations and interventions for prescribing opioids.

scholarly journals Opioid Use Among Rural Medicare Beneficiaries

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 335-335
Author(s):  
Yvonne Jonk ◽  
Heidi O'Connor ◽  
Karen Pearson ◽  
Zachariah Croll ◽  
John Gale
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Primary Care Providers ◽  
Community Dwelling ◽  
Prescribing Patterns ◽  
Medicare Beneficiaries ◽  
Care Providers ◽  
Opioid Prescription ◽  
Opioid Prescribing

Abstract This study examines differences in opioid prescribing rates among a nationally representative sample of Medicare beneficiaries across rural and urban areas, as well as among beneficiaries with chronic overlapping pain conditions (COPCs). We assess whether prescribing patterns exceed the Centers for Disease Control and Prevention guidelines for dose and duration, and identify socioeconomic and health risk factors associated with opioid prescribing using logistic regression analyses. Data were from the 2010-2017 Medicare Current Beneficiary Survey files. Rural-Urban Commuting Area codes were used to identify patients’ residential location. The Area Health Resource Files were used to identify market characteristics such as primary care and mental health shortage areas. With the exception of 2010, over years 2011-2017, higher percentages of community-dwelling rural beneficiaries received opioid prescriptions (21.8-25.4%) compared to their urban counterparts (19.1-23.7%). During the same time period, facility-dwelling rural beneficiaries were more likely to receive opioid prescriptions (39.8-47.2%) compared to their urban counterparts (28.8-35.0%). Higher percentages (18.8%) of the community dwelling population in rural had COPCs compared to urban (15.2%), and a higher percentage of rural beneficiaries with COPCs (31.4%) received an opioid prescription than their urban counterparts (22.2%). Previous research points to other factors contributing to a lack of alternatives to opioids for pain management in rural areas, including greater reliance on primary care providers, lack of access to chronic pain specialists and alternative therapies, and travel barriers. Improving the capacity of rural primary care to deal with COPCs and expanding access to specialists via telehealth warrants further attention from policymakers.

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