018 Management of migraine in the australian emergency department

2018 ◽  
Vol 89 (6) ◽  
pp. A8.2-A9
Author(s):  
Lakshini Gunasekera ◽  
Christina Sun-Edelstein ◽  
John Heywood ◽  
Lauren Sanders
Keyword(s):  
Emergency Department ◽  
Prescribing Patterns ◽  
Migraine Treatment ◽  
Primary Headaches ◽  
Opioid Use ◽  
National Guidelines ◽  
Chi Square ◽  
Opioid Prescription ◽  
Work Related ◽  
Icd 10

IntroductionAcute migraine commonly causes significant personal, economic and work-related disability. Australian guidelines recommend treating mild migraine with aspirin and metoclopramide, and moderate-severe migraine with prochlorperazine, chlorpromazine or sumatriptan. Stratified treatment based on severity is preferred to step-wise treatment. Australian data regarding Emergency Department (ED) migraine treatment are scarce. We evaluated prescribing patterns at a Melbourne hospital against national guidelines.MethodsRetrospective cohort study of migraine (G439 ICD-10-AM) between 2012–2016. Exclusion criteria included migraine without headache, other primary headaches and secondary headaches. Demographic and prescribing data were extracted from medical records. Proportions were calculated with 95% confidence intervals using Wilson’s method. Comparisons were made between groups using Mann-Whitney and Chi-square tests.ResultsOf 214,932 ED presentations, 744 with headache presentation received a G439 diagnosis. Most were female (75%; 558/744), young (mean age 34±13 years) and self-reported migraine history (75%; 558/744). There were 55 different medications prescribed. Paracetamol was more frequently prescribed (52%; 385/744) than aspirin (10.6%; 78/744). Opioid prescription occurred in 46% (345/744), single opioid 36% (267/744),>1 opioid 10% (78/744). Median time-to-discharge was 38 min longer with opioid prescription compared with no opioid (222; IQR 164–309 vs 184; 122–258; p<0.01). Just 6.85% (51/744) received triptans. Other treatments were prochlorperazine (14%; 97/744), metoclopramide (38%; 286/744) and chlorpromazine (44%; 3 25/744). Overall, 25.4% (189/744) received no guideline-recommended medication.ConclusionWe observed considerable polypharmacy in ED migraine management with inconsistent prescribing patterns. Recommended medications are infrequently used. Opioid use is common and associated with increased time-to-discharge. Failure of ED staff to follow guidelines is unexplained, and requires further investigation.

Treatment of Acute Gout Flares in the Emergency Department: Prescribing Patterns and Revisit Rates

2021 ◽  
pp. 106002802110322
Author(s):  
Luigi Brunetti ◽  
Janaki Vekaria ◽  
Peter E. Lipsky ◽  
Naomi Schlesinger
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
The United States ◽  
Prescribing Patterns ◽  
Care Providers ◽  
Opioid Use ◽  
Hospital Visit ◽  
Opioid Prescription ◽  
Anti Inflammatory ◽  
Gout Flares

Background The incidence and health care costs of gout flares have increased in the United States. The increased costs may be a result of a lack of adherence to treatment guidelines and medication knowledge. Identifying causes for this trend is vital to mitigate inappropriate resource use. Objectives The aim was to identify pharmacotherapy use related to gout treatment before, during hospital visit or stay, and on discharge in patients presenting to the emergency department (ED) with gout flares. Secondary end points included opioid use, revisit rates, and associated risk factors. Methods We performed a retrospective cohort study at a community teaching hospital ED. All consecutive patients visiting the ED from January 2016 to July 2019 with a primary diagnosis of gout flare were included. Data were extracted from the electronic medical records. Results The analysis included 214 patients. Anti-inflammatory medication was not prescribed in 33.6% during the hospital visit and 29.6% of patients on discharge. History of opioid use (odds ratio [OR] = 3.3; 95% CI = 1.3-8.6; P = 0.014) and gastroesophageal reflux disease (OR = 3.5; 95% CI = 1.09-10.9; P = 0.035) were associated with opioid prescription on discharge. ED revisits within 90 days for any gout-related or non–gout-related cause were recorded in 16.8% of patients. Conclusion and Relevance Roughly 30% of patients did not receive an anti-inflammatory on discharge, and opioids were frequently overused in gout management in the ED. There is an opportunity for further education of health care providers regarding gout treatment.

scholarly journals MP58: Have opioid prescription by emergency physicians changed significantly over five years?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S63-S63
Author(s):  
M. Wei ◽  
M. Da Silva ◽  
J. Perry
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Tertiary Care ◽  
Opioid Analgesia ◽  
Emergency Physicians ◽  
Prescribing Practices ◽  
Chi Square ◽  
Opioid Prescription ◽  
Emergency Department Care ◽  
Undetermined Etiology

Introduction: It is believed by some that emergency physicians prescribe more opioids than required to manage patients’ pain, and this may contribute to opioid misuse. The objective of our study was to assess if there has been a change in opioid prescribing practices by emergency physicians over time for undifferentiated abdominal pain. Methods: A medical record review for adult patients presenting at two urban academic tertiary care emergency departments was conducted for two distinct time periods; the years of 2012 and 2017. The first 500 patients within each time period with a discharge diagnosis of “abdominal pain” or “abdominal pain not yet diagnosed” were included. Data were collected regarding analgesia received in the emergency department and opioid prescriptions written. Opioids were standardized into morphine equivalent doses to compare quantities of opioids prescribed. Analyses included t-test for continuous and chi-square for categorical data. Results: 1,000 patients were included in our study. The mean age was 42.0 years and 69.6% of patients were female. Comparing 2017 to 2012, there was a non-significant decrease in opioid prescriptions written for patients discharged directly by emergency physicians, from 17.8% to 14.4% (p = 0.14). Mean opioid quantities per prescription decreased from 130.4 milligrams of morphine equivalents per prescription to 98.9 milligrams per prescription (p = 0.002). 13.9% of opioid prescriptions in 2017 were for more than 3 days, which is a decrease from 28.1% in 2012. During the emergency department care, there was an increase in foundational analgesia use prior to initiating opioids from 17.6% to 26.8% (p = 0.001). There was also a decrease for within ED opioid analgesia use from 40.0% to 32.8% (p = 0.018). Conclusion: Opioid prescription rates did not change significantly during our study. However, physicians reduced the quantity of opioids per prescription and used less opioid analgesia in the emergency department for abdominal pain of undetermined etiology.

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.

Opioid prescription patterns among patients with fibromyalgia

2019 ◽  
Vol 15 (6) ◽  
pp. 469-477 ◽  
Author(s):  
Caio V. M. Sarmento, PT, PhD ◽  
Mehrdad Maz, MD ◽  
Taylor Pfeifer, DPT ◽  
Marco Pessoa, PhD ◽  
Wen Liu, PhD
Keyword(s):  
Prescribing Patterns ◽  
Chi Square ◽  
Opioid Prescription ◽  
Healthcare Enterprise ◽  
The Us ◽  
Chi Square Test ◽  
Opioid Medications ◽  
Chronic Pain Conditions ◽  
Opioid Users ◽  
Harmful Effects

Objectives: To investigate opioid prescribing patterns among patients with fibromyalgia (FM) in terms of age, gender, race, type of opioids, and to examine changes in opioid prescription over the past 8 years compared to the US Food and Drug Administration (FDA)-approved FM medications.Design: Retrospective review of data using the Healthcare Enterprise Repository for Ontological Narration database. The collected data were analyzed descriptively and a chi-square test for trend was used to analyze a possible linear relationship between the proportions of opioid and non-opioid users along the time.Participants: Patients with a diagnosis of FM who had received opioid prescriptions from January 1, 2010 to December 31, 2017, and FM patients who had received prescriptions of FDA-approved FM medications in the same period. Main outcome measure: Trends in opioid and non-opioid prescriptions in patients with FM.Results: The opioid medications were prescribed more frequently in 2010 (40 percent) and 2011 (42 percent), but the percentages have decreased since 2012 and reached the lowest numbers in 2016 (27 percent). The chi-square test for trend shows that from 2010 to 2017 the prescriptions of opioids had a statistically significant (p 0.0001) decrease.Conclusion: This study suggests that the frequency of prescribed opioids in FM patients has decreased since 2012. This decline could be attributed to (1) FDA monitoring programs, (2) national efforts to increase awareness of the addictive and harmful effects of opioids, and (3) the growing research on the efficacy of non-opioid therapies to treat chronic pain conditions including FM.

Patient health literacy and the receipt of opioids in the emergency department

2019 ◽  
Vol 15 (4) ◽  
pp. 267-270
Author(s):  
Joseph A. Dayaa, MS ◽  
Montika Bush, PhD, MS ◽  
Natalie L. Richmond, BA ◽  
Lewis S. Nelson, MD ◽  
Timothy F. Platts-Mills, MD, MSc
Keyword(s):  
Emergency Department ◽  
Health Literacy ◽  
Formal Education ◽  
Opioid Use ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Low Health Literacy ◽  
Percent Difference ◽  
Patient Health ◽  
To Receive

Objective: Assess relationships between patient health literacy and formal education and use of opioids during and following an emergency department (ED) visit.Design: Prospective, cross-sectional study.Setting: Academic ED.Participants: Adults aged ≥ 60 years presenting to the ED with musculoskeletal pain.Main outcome measures: Opioid use during and after an ED visit.Results: In a sample of 136 patients, patients with low health literacy were more likely to receive an opioid in the ED than patients with high health literacy (70 percent vs 52 percent; 18 percent difference, 95% confidence interval [CI]: –1 percent, 35 percent), receive an opioid prescription (63 percent vs 44 percent; 19 percent difference, 95% CI: 1 percent, 37 percent), and take opioids during the week following the ED visit (48 percent vs 29 percent; 18 percent difference, 95% CI: 0 percent, 36 percent).Conclusions: A greater proportion of older adults receiving ED care for musculoskeletal pain with low health literacy receive and use opioids during and following an ED visit.

scholarly journals Systemic-opioid prescribing patterns and total cost of care in patients initiating spinal cord stimulation therapy: a retrospective analysis

Pain Medicine ◽  
2021 ◽  
Author(s):  
Eduardo M Fraifeld ◽  
John A Hatheway ◽  
Christine N Ricker
Keyword(s):  
Spinal Cord ◽  
Primary Endpoint ◽  
Spinal Cord Stimulation ◽  
Cost Of Care ◽  
Prescribing Patterns ◽  
Prescription Data ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Out Of Pocket Payments

Abstract Background Few studies have evaluated patterns of systemic opioid use among patients initiating spinal cord stimulation therapy for chronic pain. This study evaluated systemic opioid discontinuation and/or dose reduction, and total healthcare cost following start of spinal cord stimulation therapy. Methods Using a commercial insurance claims database (2008-2017), we analyzed opioid utilization patterns in patients initiating spinal cord stimulation therapy, over a 1-year baseline and 2 year follow-up. The primary endpoint was defined as either discontinuation (= 365-day gap between prescription fills or total days' supply in follow-up = 30 days) OR = 50% reduction in average daily morphine milligram equivalent dose. “Costs” were defined as total payer plus patient out-of-pocket payments. Results 5,878 patients met selection criteria. 152 (2.6%) showed no opioid prescription data at any point in the study period. Among patients with one or more prescriptions, 42.0% met the primary endpoint (22.0% discontinued and 20.0% reduced their dose by 50% or more). Mean total adjusted costs were significantly reduced in years 1 and 2 of follow-up relative to baseline (excluding device insertion costs). The average time to breakeven when accounting for device trial and permanent insertion cost was 3.1 years among those that met the composite endpoint and 4.2 years among those who did not. Conclusions This analysis shows that among patients who continue spinal cord stimulation therapy for at least two years, a significant proportion were able to reduce and/or discontinue systemic opioid use, with costs following start of therapy significantly reduced relative to baseline.

EPR19-069: Opioid Use Among Cancer Patients Undergoing Surgery and Their Associated Risk of Re-admissions and Emergency Department Visits in the 1-Year Postsurgical Period

2019 ◽  
Vol 17 (3.5) ◽  
pp. EPR19-069 ◽  
Author(s):  
Siyana Kurteva ◽  
Robyn Tamblyn ◽  
Ari Meguerditchian
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Healthcare System ◽  
Emergency Department Visits ◽  
Administrative Claims ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Ed Visits ◽  
Opioid Users ◽  
The Impact

Background: Prescription opioid use and overdose has steadily increased over the past years, resulting in a dramatic increase in opioid-related emergency department (ED) visits and hospitalizations. Methods: This study used a prospective cohort of cancer patients having undergone surgery in Montreal (Quebec) to describe their post-discharge opioid use and identify potential patterns of unplanned health service use (ED visits, hospitalizations). Provincial health administrative claims were used to measure opioid dispensation as well as hospital re-admissions and ED visits. The hospital warehouse, patient chart and patient interview will be used to further describe patient’s medical profile. Marginal structural models will be used to model the association between use of opioids and risk of ED visits and hospitalizations. Inverse probability of treatment and censoring weights will be constructed to properly adjust for confounders that may be unbalanced between the opioid and non–opioid users as well as to account for competing risk due to mortality. Reasons for the re-admissions will also be presented as part of the analyses. Covariates will include patient comorbidities, medication history, and healthcare system characteristics such as nurse-to-patient and attending physician-to-patient ratios. Results (interim): A total of 821 were included in the study; of these, 73% (n=597) were admitted for a cancer procedure. At postoperative discharge, 605 (74%) of patients had at least one opioid dispensation, of which the majority (67%) were oxycodone with hydromorphone being the second most prescribed (28%). Among those who filled a prescription, mean age was 66 (13.4), 68% had no previous history of opioid use, and 10% have had 3 or more dispensing pharmacies in the year prior to admission, compared to less than 1% for the non–opioid users. Overall, 343 people refilled their opioid prescription at least once and 128 at least twice during the 1-year postoperative period. Among cancer patients who were opioid users, 214 ED visits occurred in the 1 year after surgery compared to only 40 for the non-cancer opioid users. Conclusion: This study will help to identify the risk profile of cancer patients who are most likely to continue using opioids for prolonged periods following surgical procedures as well as quantify the impact of opioid use and its associated burden on the healthcare system in order to identify areas for possible interventions.

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 It Is Time to Implement Primary Prevention in the Workplace to Ameliorate the Ongoing U.S. Opioid Epidemic

2021 ◽  
pp. 104829112110398
Author(s):  
Aurora B. Le ◽  
Jonathan D. Rosen
Keyword(s):  
Primary Prevention ◽  
The United States ◽  
Evidence Base ◽  
Opioid Epidemic ◽  
Physical And Mental Health ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Health Crisis ◽  
Work Related ◽  
Negative Impacts

The United States’ opioid public health crisis continues having disastrous consequences on communities, including workers and employers. From May 2019 to May 2020, the largest number of drug overdose deaths was recorded over a twelve-month period. The “twindemics” of COVID-19 and opioids underscore the urgent need to address workers’ physical and mental health. Although much has been written about the negative impacts of the opioid epidemic on the workplace, few initiatives have focused on primary prevention, addressing work-related root causes of opioid use disorders (e.g., injury, stress) that may lead to prescription or illicit opioid use. We suggest primary prevention efforts to address the connection between workplace hazards and opioid misuse, dependence, and addiction such as examining patterns of work injury and stress with records of opioid prescription. Government funding should be expanded to support primary prevention and research efforts to strengthen the evidence-base to support workplace primary prevention endeavors.

Opioid use after outpatient elective general surgery: quantifying the burden of persistent use

2021 ◽  
pp. 204946372110329
Author(s):  
Collin Clarke ◽  
Andrew McClure ◽  
Laura Allen ◽  
Luke Hartford ◽  
Julie Ann Van Koughnett ◽  
...  
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Prescribing Patterns ◽  
Income Quintile ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Open Inguinal Hernia Repair

Purpose: Surgery is a major risk factor for chronic opioid use among patients who had not recently been prescribed opioids. This study identifies the rate of, and risk factors for, persistent opioid use following laparoscopic cholecystectomy and open inguinal hernia repair in patients not recently prescribed opioids. Methods: This retrospective population-based cohort study included all patients who had not been prescribed opioids in the 6 months prior to undergoing open inguinal hernia repair or laparoscopic cholecystectomy from January 2013 to July 2016 in Ontario. Opioid prescription was identified from the provincial Narcotics Monitoring System and data were obtained from the Institute for Clinical Evaluative Sciences. The primary outcome was persistent opioid use after surgery (3, 6, 9 and 12 months). Associated risk factors and prescribing patterns were also examined. Results: Among the 90,326 patients in the study cohort, 80% filled an opioid prescription after surgery, with 11%, 9%, 5% and 1% filling a prescription at 3, 6, 9 and 12 months, respectively. Significant variability was identified in the type of opioid prescribed (41% codeine, 31% oxycodone, 18% tramadol) and in regional prescribing patterns (mean prescription/region range, 135–225 oral morphine equivalents). Predictors of continued opioid use included age, female gender, lower income quintile and being operated on by less experienced surgeons. Conclusion: Most patients who undergo elective cholecystectomy and hernia repair will fill a prescription for an opioid after surgery, and many will continue to fill opioid prescriptions for considerably longer than clinically anticipated. There is important variability in opioid type, regional prescribing patterns and risk factors that identify strategic targets to reduce the opioid burden in this patient population.

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