Variation Between Physicians and Mid-level Providers in Opioid Treatment for Musculoskeletal Pain in the Emergency Department

Thomas, Stephen; Mumma, Shannon; Haas, Tyler; Arthur, Ami; Todd, Knox H.; Mace, Sharon E.; Diercks, Deborah B.; Pollack, Charles V.

doi:10.1016/j.jemermed.2015.05.036

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…24 In the emergency setting, however, studies have shown conflicting results. One multi-center study found that APPs were less likely to prescribe an opioid for musculoskeletal pain 25 , whereas a larger but single-center study reported the opposite finding (for a broader range of diagnoses). 26 Because APPs are commonly utilized to improve physician productivity and access to care 27 , they may be the recipients of postoperative opioid refill requests and be hesitant to prescribe smaller amounts.…”

Section: Discussionmentioning

confidence: 98%

Provider Characteristics Associated With Outpatient Opioid Prescribing After Surgery

et al. 2020

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Objective: To characterize differences in postoperative opioid prescribing across surgical, nonsurgical, and advanced practice providers. Background: There is a critical need to identify best practices around perioperative opioid prescribing. To date, differences in postoperative prescribing among providers are poorly understood. Methods: This is a retrospective multi-center analysis of commercial insurance claims from a statewide quality collaborative. We identified 15,657 opioid-naïve patients who underwent a range of surgical procedures between January 2012 and October 2015 and filled an opioid prescription within 30 days postoperatively. Our primary outcome was total amount of opioid filled per prescription within 30 days postoperatively (in oral morphine equivalents [OME]). Hierarchical linear regression was used to determine the association between provider characteristics (specialty, advanced practice providers [nurse practitioners and physician assistants] vs. physician, and gender) and outcome while adjusting for patient factors. Results: Average postoperative opioid prescription amount was 326 ± 285 OME (equivalent: 65 tablets of 5 mg hydrocodone). Advanced practice providers accounted for 19% of all prescriptions, and amount per prescription was 18% larger in this group compared to physicians (315 vs. 268, P<0.001). Primary care providers accounted for 13% of all prescriptions and prescribed on average 279 OME per prescription. The amount of opioid prescribed varied by surgical specialty and ranged from 178 OME (urology) to 454 OME (neurosurgery).

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Section: Discussionmentioning

confidence: 98%

Provider Characteristics Associated With Outpatient Opioid Prescribing After Surgery

et al. 2020

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“…54 By contrast, studies in the emergency department found that APPs were less likely to prescribe high-risk opioids. 55 Another study found PCPs were more likely to prescribe opioids than specialists, but surgeons and hospital-based specialists prescribed higher doses than PCPs. 52 However, no prior work has examined the extent to which individual clinicians prescribe differently to different patients.…”

Section: Discussionmentioning

confidence: 99%

An Exploratory Analysis of Differential Prescribing of High-Risk Opioids by Insurance Type Among Patients Seen by the Same Clinician

et al. 2023

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Background Insurance status may influence quality of opioid analgesic (OA) prescribing among patients seen by the same clinician. Objective To explore how high-risk OA prescribing varies by payer type among patients seeing the same prescriber and identify clinician characteristics associated with variable prescribing Design Retrospective cohort study using the 2016–2018 IQVIA Real World Data – Longitudinal Prescription Participants New OA treatment episodes for individuals ≥ 12 years, categorized by payer and prescriber. We created three dyads: prescribers with ≥ 10 commercial insurance episodes and ≥ 10 Medicaid episodes; ≥ 10 commercial insurance episodes and ≥ 10 self-pay episodes; and ≥ 10 Medicaid episodes and ≥ 10 self-pay episodes. Main Outcome(s) and Measure(s) Rates of high-risk episodes (initial opioid episodes with > 7-days’ supply or prescriptions with a morphine milliequivalent daily dose >90) and odds of being an unbalanced prescriber (prescribers with significantly higher percentage of high-risk episodes paid by one payer vs. the other payer) Key Results There were 88,352 prescribers in the Medicaid/self-pay dyad, 172,392 in the Medicaid/commercial dyad, and 122,748 in the self-pay/commercial dyad. In the Medicaid/self-pay and the commercial-self-pay dyads, self-pay episodes had higher high-risk episode rates than Medicaid (16.1% and 18.4%) or commercial (22.7% vs. 22.4%). In the Medicaid/commercial dyad, Medicaid had higher high-risk episode rates (21.1% vs. 20.4%). The proportion of unbalanced prescribers was 11–12% across dyads. In adjusted analyses, surgeons and pain specialists were more likely to be unbalanced prescribers than adult primary care physicians (PCPs) in the Medicaid/self-paydyad (aOR 1.2, 95% CI 1.16–1.34 and aOR 1.2, 95% CI 1.03–1.34). For Medicaid/commercial and self-pay/commercial dyads, surgeons had lower odds of being unbalanced compared to PCPs (aOR 0.6, 95% CI 0.57–0.66 and aOR 0.6, 95% CI 0.61–0.68). Conclusions Clinicians prescribe high-risk OAs differently based on insurance type. The relationship between insurance and opioid prescribing quality goes beyond where patients receive care.

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“…[10][11][12][13][14] Therefore, although clinicians are aware of the importance of balancing patient safety and quality care, there is growing hesitation among the emergency medicine community as providers attempt to discern the role of opioid drugs in managing pain and weighing the risks of under-treatment versus opioid overuse. 15 This issue is especially prevalent in Northwest Ohio which has one of the greatest amounts of prescription opioid overdoses in the state. In 2015, Lucas County had the eighth highest number of fentanyl -related overdoses in the state with 41 deaths.…”

Section: Introductionmentioning

confidence: 99%

Opioid Dispensing Practices in the Acute Care Setting: A Retrospective Study

Moussa

Vemuru

Dohar

et al. 2020

OJPH

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Background: Ohio remains one of the most afflicted states nationally with 46.3 per 100 000 deaths due to drug overdose. Opioids are commonly administered in emergency departments for the management of pain. Given the high volume of patients presenting with pain, emergency clinicians must be cognizant of responsible opioid dispensing practices. Ohio established guidelines in April 2012 to provide a general approach for responsible opioid prescribing practices in the emergency setting. The purpose of this study assesses clinician opioid dispensing before and after the implementation of the Ohio Opioid Prescribing Guidelines. Methods: The study design used retrospective data analysis of opioid medications ordered by emergency clinicians to be administered in the emergency room between January 1, 2007, to December 31, 2017, at the University of Toledo Medical Center. A segmented regression analysis with an interrupted time series was used to determine impact. Results: All opioid medication usage showed a significant decrease after guideline implementation except for morphine and fentanyl which showed statistically significant increases in administration over time (P < 0.05). Conclusion: There was a significant decrease in the use of opioids since the implementation of the Ohio Opioid Prescribing Guidelines, yet morphine and fentanyl use has generally increased across all age groups. Age demographics frequently receiving opioids in the emergency room have seemed to shift over time as well as specific opioid drugs dispensed for the management of pain in certain age groups. Further study is needed to evaluate the use of opioids prescribed by emergency physicians after discharge from the emergency department.

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Variation Between Physicians and Mid-level Providers in Opioid Treatment for Musculoskeletal Pain in the Emergency Department

Cited by 3 publications

References 31 publications

Provider Characteristics Associated With Outpatient Opioid Prescribing After Surgery

Provider Characteristics Associated With Outpatient Opioid Prescribing After Surgery

An Exploratory Analysis of Differential Prescribing of High-Risk Opioids by Insurance Type Among Patients Seen by the Same Clinician

Opioid Dispensing Practices in the Acute Care Setting: A Retrospective Study

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