239 Evaluating the Role of Recovery Capital on Willingness to Enter Treatment for Emergency Department Patients With Opioid Use Disorders

Abstract

opioid antitussive prescribing among UC and ED visits with respiratory diagnoses in a large health system.Methods: This is an IRB-approved cross-sectional study of visits to seven EDs and six UCs in the greater Chicago area. We included all ICC visits and discharged ED visits from July 2017 through June 2019 with a primary ICD-10 diagnosis of a nonbacterial upper or lower respiratory issue. We describe demographic and clinical visit characteristics with means, medians, or proportions. The primary descriptive outcome was the proportion of visits with an antibiotic or antitussive prescription with 95% confidence intervals (95% CI).Results: There were 26,304 visits for non-bacterial respiratory diagnoses during the study period (9,523 ED, 16,781 UC). Median wait time was 15 and 4 minutes for ED and UC visits, respectively; median length of stay was 162 and 42 minutes, respectively. UC visits reflected an older patient population that was more frequently commercially insured and White, with a lower prevalence of co-morbidities (Table ). Among all ED visits, 33.4% (95% CI: 32.4-34.3%) were prescribed an antibiotic and 13.1% (95% CI: 12.4-13.8%) an antitussive; 6.1% (95% CI 5.7-6.6%) were prescribed an opioid. Among all UC visits, 60.8% (95% CI: 60.1-61.6%) were prescribed an antibiotic and 23.9% (95% CI: 23.3-24.6%) an anti-tussive; 11.1% (95% CI: 10.6-11.5%) were prescribed an opioid. Among antibiotics prescribed from ED and UC visits, penicillins (39.6% and 46.0%, respectively) and macrolides (42.2% and 36.5%, respectively) were most common. Among antitussives prescribed from ED and UC visits, benzonatate (44.4% and 55.7%, respectively) and opioids (46.8% and 46.2%, respectively) were most common. The most frequently prescribed opioid was codeine (56.9% and 87.5% of all opioids, respectively).Conclusion: Antibiotics and opioid antitussives are frequently prescribed for ED and UC visits with non-bacterial respiratory diagnoses, despite their lack of clinical utility and associated risks. These findings suggest that greater attention is warranted to the appropriateness of antibiotic and antitussive prescribing in both settings. Furthermore, specific guidelines relating to codeine prescribing may be beneficial, given the high incidence of codeine prescribing found in this study.