PRESCRIPTIONS OF OPIOID-CONTAINING DRUGS IN PATIENTS WITH CHRONIC COUGH

Abstract

SESSION TITLE: Wednesday Electronic Posters 5 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Chronic cough (CC) of eight or more weeks affects up to 10% of adults and may lead to numerous treatments, including opioid-containing cough suppressants (OCCS), but the use of OCCS to treat CC has not been characterized. We identified and characterized the utilization of such drugs among a cohort of patients. METHODS: Using a combination of diagnostic codes, information about prescriptions, and natural language processing to analyze text, we used electronic health records to identify patients aged 18 to 85 years who had cough and received care in a Midwestern academic medical institution between 2006 and 2015. The index date was the first date with cough during the study period. We identified patients with cough as CC (three or more encounters with cough within 56-120 days) or non-CC (one or two encounters). OCCS were opioids containing codeine, dihydrocodeine, or hydrocodone. Descriptive statistics identified the CC cohort’s age, gender, race, primary insurance, and prescriptions of opioids. Demographic comparisons were made to the non-CC cohort using Student’s t-test or Pearson’s chi-square test as appropriate. Multivariable modeling of number of prescriptions was conducted using zero-inflated Poisson models. RESULTS: Compared to non-CC (N=445,116), the CC cohort (N=25,593) had more women (65% vs. 58%) and Medicare (37% vs. 22%), and was older (mean age 54 vs. 47 years) and more white (72% vs. 64%). The CC cohort had 18% African-Americans, 30% commercial insurance, and 19% Medicaid. In the first year after the index date, OCCS prescriptions represented 71% of 21,627 antitussive orders, and 22% of patients (vs. 6.3% of those with non-CC). Among these patients, 35% had at least three OCCS prescriptions. In the CC cohort, OCCS drugs were ordered in 39% with Medicaid, 19% with Medicare, and 16% with commercial insurance. The number of OCCS prescriptions per 100 patients was 60 for CC (total of 15,274) vs. 12 for non-CC. More than ten OCCS prescriptions were ordered for 157 (0.6%) of the patients. In multivariable modeling adjusting for cohort, age, race, gender, urbanicity, insurance, and year, patients were more likely to have at least one OCCS prescription if they had CC (OR 2.9 compared to non-chronic cough), or were non-white (OR 1.2), urban (OR 1.2), or with Medicaid (OR 2.4) or self-pay insurance (OR 1.2, compared to commercial insurance). More OCCS orders occurred in patients with CC (1.8-fold increase compared to non CC) or self-pay insurance (1.4-fold). CONCLUSIONS: About one in five patients with CC received an OCCS prescription, which was more likely in this cohort than in patients with non-CC. Among patients with CC, OCCS prescriptions were more likely among patients with Medicaid, compared to those with other primary insurance. Most antitussive prescriptions for patients with CC contained opioids. CLINICAL IMPLICATIONS: Findings could foster improvements in effectiveness of treating CC. DISCLOSURES: No relevant relationships by Paul Richard Dexter, source=Admin input Employee relationship with Merck & Co., Inc. Please note: $20001 - $100000 Added 02/15/2019 by Ishita Doshi, source=Web Response, value=Salary No relevant relationships by Ashley Griffith, source=Web Response No relevant relationships by Ziyue Liu, source=Admin input No relevant relationships by Anna Roberts, source=Web Response Employee relationship with Merck Please note: $1-$1000 Added 03/15/2019 by Eric Sarpong, source=Admin input, value=Salary Employee relationship with Merck & Co., Inc. Please note: >$100000 Added 03/16/2019 by Jonathan Schelfhout, source=Web Response, value=Salary Employee relationship with Merck & Co. INc. Please note: >$100000 Added 03/12/2019 by Jessica Weaver, source=Web Response, value=Salary Grantee relationship with Merck & Co., Inc. Please note: >$100000 Added 03/04/2019 by Michael Weiner, source=Web Response, value=Grant/Research Support