Abstract
BackgroundThe duration of an opioid prescribed at hospital discharge does not intrinsically account for opioid needs during a hospitalization. This discrepancy may lead to patients receiving much larger supplies of opioids on discharge than they truly require.ObjectiveAssess a novel discharge opioid supply metric that adjusts for opioid use during hospitalization, compared to the conventional discharge prescription signature.Design, setting, & participantsRetrospective study using electronic health record data from June 2012 to November 2018 of adults who received opioids while hospitalized and after discharge from a single academic medical center.Measures & analysisWe ascertained inpatient opioids received and milligrams of opioids supplied after discharge, then determined days of opioids supplied after discharge by the conventional prescription signature opioid-days (“conventional days”) and novel hospital-adjusted opioid-days (“adjusted days”) metrics. We calculated descriptive statistics, within-subject difference between measurements, and fold difference between measures. We used multiple linear regression to determine patient-level predictors associated with high difference in days prescribed between measures.ResultsThe adjusted days metric demonstrates a 2.4 day median increase in prescription duration as compared to the conventional days metric (9.4 vs. 7.0 days; P<0.001). 95% of all adjusted days measurements fall within a 0.19 to 6.90-fold difference as compared to conventional days measurements, with a maximum absolute difference of 640 days. Receiving a liquid opioid prescription accounted for an increased prescription duration of 135.6% by the adjusted days metric (95% CI 39.1–299.0%; P = 0.001). Of patients who were not on opioids prior to admission and required opioids during hospitalization but not in the last 24 hours, 325 (8.6%) were discharged with an opioid prescription.ConclusionsThe adjusted days metric, based on inpatient opioid use, demonstrates that patients are often prescribed a supply lasting longer than the prescription signature suggests, though with marked variability for some patients that suggests potential under-prescribing as well. Adjusted days is more patient-centered, reflecting the reality of how patients will take their prescription rather than providers’ intended prescription duration.
Highlights
We ascertained inpatient opioids received and milligrams of opioids supplied after discharge, determined days of opioids supplied after discharge by the conventional prescription signature opioid-days (“conventional days”) and novel hospital-adjusted opioiddays (“adjusted days”) metrics
The adjusted days metric demonstrates a 2.4 day median increase in prescription duration as compared to the conventional days metric (9.4 vs. 7.0 days; P
Prolonged opioid prescriptions and higher daily doses of opioids have been associated with significantly increased risk of development of chronic opioid therapy, opioid use disorder, and opioid overdose [1,2,3]
Summary
Citation: Iverson NR, Lau CY, Abe-Jones Y, Fang MC, Kangelaris KN, Prasad P, et al (2020) Evaluation of a novel metric for personalized opioid prescribing after hospitalization. PLoS ONE 15(12): e0244735. https://doi.org/10.1371/journal. pone.0244735 The duration of an opioid prescribed at hospital discharge does not intrinsically account for opioid needs during a hospitalization. This discrepancy may lead to patients receiving much larger supplies of opioids on discharge than they truly require.
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