Marisha Burden1, Angela Keniston1,2, Mary Anderson Wallace1, Jason W Busse3, Jordi Casademont4, Smitha R Chadaga5, Sumitra Chandrasekaran5, Marco Cicardi6, John M Cunningham1,2, David Filella4, Daniel Hoody7, David Hilden7, Ming-Ju Hsieh8, Yoon-Seon Lee9, Daniel D Melley10, Anna Munoa1,2, Francesca Perego11, Chin-Chung Shu8, Chang Hwan Sohn9, Jeffrey Spence1,2, Lindsay Thurman1, Cindy R Towns12,13, John You14, Luca Zocchi15, Richard K Albert16. 1. Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado. 2. Denver Health, Denver, Colorado. 3. Department of Anesthesia, Department of Health, Evidence and Impact; Michael G Degroote Institute for Pain Research and Care; Michael G Degroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada. 4. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. 5. Legacy Health, Portland, Oregon. 6. Istituti Clinici Scientifici Maugeri; University of Milan, Italy. 7. Hennepin Healthcare, Minneapolis, Minnesota. 8. National Taiwan University Hospital, Taipei, Taiwan. 9. Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea. 10. Imperial College, Chelsea and Westminster Hospital, London, United Kingdom. 11. Istituti Clinici Scientifici Maugeri, Milan, Italy. 12. Wellington Hospital, Newtown, Wellington, New Zealand. 13. University of Otago, Wellington New Zealand. 14. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 15. Angelo Bellini Hospital (Somma Lombardo), Internal Medicine and Cardiac Rehab. Lombardia, Italy. 16. Department of Medicine, University of Colorado School of Medicine., Aurora, Colorado.
Abstract
BACKGROUND: Hospitalized patients are frequently treated with opioids for pain control, and receipt of opioids at hospital discharge may increase the risk of future chronic opioid use. OBJECTIVE: To compare inpatient analgesic prescribing patterns and patients' perception of pain control in the United States and non-US hospitals. DESIGN: Cross-sectional observational study. SETTING: Four hospitals in the US and seven in seven other countries. PARTICIPANTS: Medical inpatients reporting pain. MEASUREMENTS: Opioid analgesics dispensed during the first 24-36 hours of hospitalization and at discharge; assessments and beliefs about pain. RESULTS: We acquired completed surveys for 981 patients, 503 of 719 patients in the US and 478 of 590 patients in other countries. After adjusting for confounding factors, we found that more US patients were given opioids during their hospitalization compared with patients in other countries, regardless of whether they did or did not report taking opioids prior to admission (92% vs 70% and 71% vs 41%, respectively; P < .05), and similar trends were seen for opioids prescribed at discharge. Patient satisfaction, beliefs, and expectations about pain control differed between patients in the US and other sites. LIMITATIONS: Limited number of sites and patients/country. CONCLUSIONS: In the hospitals we sampled, our data suggest that physicians in the US may prescribe opioids more frequently during patients' hospitalizations and at discharge than their colleagues in other countries, and patients have different beliefs and expectations about pain control. Efforts to curb the opioid epidemic likely need to include addressing inpatient analgesic prescribing practices and patients' expectations regarding pain control.
BACKGROUND: Hospitalized patients are frequently treated with opioids for pain control, and receipt of opioids at hospital discharge may increase the risk of future chronic opioid use. OBJECTIVE: To compare inpatient analgesic prescribing patterns and patients' perception of pain control in the United States and non-US hospitals. DESIGN: Cross-sectional observational study. SETTING: Four hospitals in the US and seven in seven other countries. PARTICIPANTS: Medical inpatients reporting pain. MEASUREMENTS: Opioid analgesics dispensed during the first 24-36 hours of hospitalization and at discharge; assessments and beliefs about pain. RESULTS: We acquired completed surveys for 981 patients, 503 of 719 patients in the US and 478 of 590 patients in other countries. After adjusting for confounding factors, we found that more US patients were given opioids during their hospitalization compared with patients in other countries, regardless of whether they did or did not report taking opioids prior to admission (92% vs 70% and 71% vs 41%, respectively; P < .05), and similar trends were seen for opioids prescribed at discharge. Patient satisfaction, beliefs, and expectations about pain control differed between patients in the US and other sites. LIMITATIONS: Limited number of sites and patients/country. CONCLUSIONS: In the hospitals we sampled, our data suggest that physicians in the US may prescribe opioids more frequently during patients' hospitalizations and at discharge than their colleagues in other countries, and patients have different beliefs and expectations about pain control. Efforts to curb the opioid epidemic likely need to include addressing inpatient analgesic prescribing practices and patients' expectations regarding pain control.
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