The Effects of the Opioid Epidemic on Prescribing Practices in Long-Term Care Residents

Sr Care Pharm. 2019 Apr 1;34(4):258-267. doi: 10.4140/TCP.n.2019.258.

Abstract

OBJECTIVE: Evaluate opioid prescribing practices for older adults since the opioid crisis in the United States.<br/> DESIGN: Interrupted time-series analysis on retrospective observational cohort study.<br/> SETTING: 176-bed skilled-nursing facility (SNF).<br/> PARTICIPANTS: Patients admitted to a long-term care facility with pain-related diagnoses between October 1, 2015, and March 31, 2017, were included. Residents discharged prior to 14 days were excluded. Of 392 residents, 258 met inclusion criteria with 313 admissions.<br/> MAIN OUTCOME MEASURE: Changes in opioid prescribing frequency between two periods: Q1 to Q3 (Spring 2016) and Q4 to Q6 for pre- and postgovernment countermeasure, respectively.<br/> RESULTS: Opioid prescriptions for patients with pain-related diagnoses decreased during period one at -0.10% per quarter (95% confidence interval [CI] -0.85-0.85; P = 0.99), with the rate of decline increasing at -3.8% per quarter from period 1 and 2 (95% CI -0.23-0.15; P = 0.64). Opioid prescribing from top International Classification of Diseases, Ninth Revision category, "Injury and Poisoning" decreased in prescribing frequency by -3.0% per quarter from Q1 to Q6 (95% CI -0.16-0.10; P = 0.54). Appropriateness of pain-control was obtained from the Minimum Data Set version 3.0 "Percent of Residents Who Self-Report Moderate to Severe Pain (Short Stay)" measure; these results showed a significant increase in inadequacy of pain relief by 0.28% per quarter (95% CI 0.12-0.44; P = 0.009).<br/> CONCLUSION: Residents who self-report moderate- to severe pain have significantly increased since October 2015. Opioid prescriptions may have decreased for elderly patients in SNFs since Spring 2016. Further investigation with a larger population and wider time frame is warranted to further evaluate significance.

Publication types

  • Observational Study

MeSH terms

  • Analgesics, Opioid*
  • Humans
  • Long-Term Care
  • Practice Patterns, Physicians'
  • Retrospective Studies
  • United States

Substances

  • Analgesics, Opioid