Determinants of long-term opioid use in hospitalized patients.

Autor: Kurteva S; Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.; Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.; Science, Aetion, Inc., Barcelona, Spain., Abrahamowicz M; Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada., Weir D; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands., Gomes T; Institute of Health Policy Management and Evaluation, Toronto, Canada.; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.; ICES, Toronto, Canada., Tamblyn R; Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.; Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.; Department of Medicine, McGill University Health Center, Montreal, Canada.; McGill University Health Centre, Montreal, Canada.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Dec 15; Vol. 17 (12), pp. e0278992. Date of Electronic Publication: 2022 Dec 15 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0278992
Abstrakt: Background: Long-term opioid use is an increasingly important problem related to the ongoing opioid epidemic. The purpose of this study was to identify patient, hospitalization and system-level determinants of long term opioid therapy (LTOT) among patients recently discharged from hospital.
Design: To be eligible for this study, patient needed to have filled at least one opioid prescription three-months post-discharge. We retrieved data from the provincial health insurance agency to measure medical service and prescription drug use in the year prior to and after hospitalization. A multivariable Cox Proportional Hazards model was utilized to determine factors associated with time to the first LTOT occurrence, defined as time-varying cumulative opioid duration of ≥ 60 days.
Results: Overall, 22.4% of the 1,551 study patients were classified as LTOT, who had a mean age of 66.3 years (SD = 14.3). Having no drug copay status (adjusted hazard ratio (aHR) 1.91, 95% CI: 1.40-2.60), being a LTOT user before the index hospitalization (aHR 6.05, 95% CI: 4.22-8.68) or having history of benzodiazepine use (aHR 1.43, 95% CI: 1.12-1.83) were all associated with an increased likelihood of LTOT. Cardiothoracic surgical patients had a 40% lower LTOT risk (aHR 0.55, 95% CI: 0.31-0.96) as compared to medical patients. Initial opioid dispensation of > 90 milligram morphine equivalents (MME) was also associated with higher likelihood of LTOT (aHR 2.08, 95% CI: 1.17-3.69).
Conclusions and Relevance: Several patient-level characteristics associated with an increased risk of ≥ 60 days of cumulative opioid use. The results could be used to help identify patients who are at high-risk of continuing opioids beyond guideline recommendations and inform policies to curb excessive opioid prescribing.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2022 Kurteva et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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