Michael L Barnett1, Andrew R Olenski1, Anupam B Jena1. 1. From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B.), the Department of Health Care Policy, Harvard Medical School (A.R.O., A.B.J.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), and the Department of Medicine, Massachusetts General Hospital (A.B.J.), Boston, and the National Bureau of Economic Research, Cambridge (A.B.J.) - all in Massachusetts.
Abstract
BACKGROUND: Increasing overuse of opioids in the United States may be driven in part by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long-term opioid use and adverse outcomes in patients are unknown. METHODS: We performed a retrospective analysis involving Medicare beneficiaries who had an index emergency department visit in the period from 2008 through 2011 and had not received prescriptions for opioids within 6 months before that visit. After identifying the emergency physicians within a hospital who cared for the patients, we categorized the physicians as being high-intensity or low-intensity opioid prescribers according to relative quartiles of prescribing rates within the same hospital. We compared rates of long-term opioid use, defined as 6 months of days supplied, in the 12 months after a visit to the emergency department among patients treated by high-intensity or low-intensity prescribers, with adjustment for patient characteristics. RESULTS: Our sample consisted of 215,678 patients who received treatment from low-intensity prescribers and 161,951 patients who received treatment from high-intensity prescribers. Patient characteristics, including diagnoses in the emergency department, were similar in the two treatment groups. Within individual hospitals, rates of opioid prescribing varied widely between low-intensity and high-intensity prescribers (7.3% vs. 24.1%). Long-term opioid use was significantly higher among patients treated by high-intensity prescribers than among patients treated by low-intensity prescribers (adjusted odds ratio, 1.30; 95% confidence interval, 1.23 to 1.37; P<0.001); these findings were consistent across multiple sensitivity analyses. CONCLUSIONS: Wide variation in rates of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers. (Funded by the National Institutes of Health.).
BACKGROUND: Increasing overuse of opioids in the United States may be driven in part by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long-term opioid use and adverse outcomes in patients are unknown. METHODS: We performed a retrospective analysis involving Medicare beneficiaries who had an index emergency department visit in the period from 2008 through 2011 and had not received prescriptions for opioids within 6 months before that visit. After identifying the emergency physicians within a hospital who cared for the patients, we categorized the physicians as being high-intensity or low-intensity opioid prescribers according to relative quartiles of prescribing rates within the same hospital. We compared rates of long-term opioid use, defined as 6 months of days supplied, in the 12 months after a visit to the emergency department among patients treated by high-intensity or low-intensity prescribers, with adjustment for patient characteristics. RESULTS: Our sample consisted of 215,678 patients who received treatment from low-intensity prescribers and 161,951 patients who received treatment from high-intensity prescribers. Patient characteristics, including diagnoses in the emergency department, were similar in the two treatment groups. Within individual hospitals, rates of opioid prescribing varied widely between low-intensity and high-intensity prescribers (7.3% vs. 24.1%). Long-term opioid use was significantly higher among patients treated by high-intensity prescribers than among patients treated by low-intensity prescribers (adjusted odds ratio, 1.30; 95% confidence interval, 1.23 to 1.37; P<0.001); these findings were consistent across multiple sensitivity analyses. CONCLUSIONS: Wide variation in rates of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers. (Funded by the National Institutes of Health.).
Authors: Joshua H Tamayo-Sarver; Neal V Dawson; Rita K Cydulka; Robert S Wigton; David W Baker Journal: Ann Emerg Med Date: 2004-04 Impact factor: 5.721
Authors: Robert Dufour; Ashish V Joshi; Margaret K Pasquale; David Schaaf; Jack Mardekian; George A Andrews; Nick C Patel Journal: Pain Pract Date: 2013-12-01 Impact factor: 3.183
Authors: Megan M Butler; Rachel M Ancona; Gillian A Beauchamp; Cyrus K Yamin; Erin L Winstanley; Kimberly W Hart; Andrew H Ruffner; Shawn W Ryan; Richard J Ryan; Christopher J Lindsell; Michael S Lyons Journal: Ann Emerg Med Date: 2016-02-11 Impact factor: 5.721
Authors: Jennifer Brennan Braden; Joan Russo; Ming-Yu Fan; Mark J Edlund; Bradley C Martin; Andrea DeVries; Mark D Sullivan Journal: Arch Intern Med Date: 2010-09-13
Authors: Matthew J Witry; Barbara J St Marie; Brahmendra Reddy Viyyuri; Paul D Windschitl Journal: Pain Manag Nurs Date: 2019-05-24 Impact factor: 1.929
Authors: Kevin C Abbott; Chyng-Wen Fwu; Paul W Eggers; Anne W Eggers; Prudence P Kline; Paul L Kimmel Journal: Transplantation Date: 2018-06 Impact factor: 4.939
Authors: Vincent X Liu; Abigail Eaton; Derrick C Lee; Vivian M Reyes; Shirley S Paulson; Cynthia I Campbell; Andy L Avins; Stephen M Parodi Journal: Ann Surg Date: 2019-12 Impact factor: 12.969
Authors: Zachary F Meisel; Nicoleta Lupulescu-Mann; Christina J Charlesworth; Hyunjee Kim; Benjamin C Sun Journal: Ann Emerg Med Date: 2019-06-20 Impact factor: 5.721
Authors: Abhiram R Bhashyam; Matthew Basilico; Michael J Weaver; Mitchel B Harris; Marilyn Heng Journal: J Orthop Trauma Date: 2019-04 Impact factor: 2.512
Authors: Keiki Hinami; Michael J Ray; Kruti Doshi; Maria Torres; Steven Aks; John J Shannon; William E Trick Journal: J Gen Intern Med Date: 2019-08-16 Impact factor: 5.128
Authors: Shoshana J Herzig; Susan L Calcaterra; Hilary J Mosher; Matthew V Ronan; Nicole Van Groningen; Lili Shek; Anthony Loffredo; Michelle Keller; Anupam B Jena; Teryl K Nuckols Journal: J Hosp Med Date: 2018-04 Impact factor: 2.960
Authors: Joseph Friedman; David Kim; Todd Schneberk; Philippe Bourgois; Michael Shin; Aaron Celious; David L Schriger Journal: JAMA Intern Med Date: 2019-04-01 Impact factor: 21.873