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Long‐acting opioid initiation in US nursing homes
Author(s) -
Hunnicutt Jacob N.,
Hume Anne L.,
Ulbricht Christine M.,
Tjia Jennifer,
Lapane Kate L.
Publication year - 2019
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4568
Subject(s) - medicine , opioid , medical prescription , odds ratio , confidence interval , cross sectional study , nursing homes , referral , emergency medicine , family medicine , nursing , receptor , pathology
Purpose To estimate the proportion of residents newly initiating long‐acting opioids in comparison to residents initiating short‐acting opioids and examine variation in long‐acting opioid initiation by region and resident characteristics. Methods This cross‐sectional study included 182 735 long‐stay nursing home residents in 13 881 US nursing homes who were Medicare beneficiaries during 2011 to 2013 and initiated a short‐acting or long‐acting opioid (excluding residents <50 years old, those with cancer, or receiving hospice care). Medicare Part D prescription claims were used to identify residents as newly initiating short‐acting or long‐acting opioids, defined as having a prescription claim for an opioid with no prior opioid prescriptions in the preceding 60 days. We estimated the overall proportion of initiators prescribed long‐acting opioids. Regional variation was examined by mapping results by state and hospital referral regions. Logistic models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results Two percent of opioid initiators were prescribed long‐acting opioids. State variation in long‐acting opioid initiation ranged from 0.6% to 7.5% (5th‐95th percentiles: 0.6‐6.4%). Resident characteristics associated with increased long‐acting opioid initiation included severe physical limitations (vs none/mild limitations; aOR: 2.13, 95% CI: 1.92‐2.37) and pain (staff‐assessed vs no pain; aOR: 1.59 95% CI: 1.40‐1.80), whereas being non‐White was inversely associated (non‐Hispanic black vs non‐Hispanic white; aOR: 0.70, 95% CI: 0.62‐0.79). Conclusion United States nursing home residents predominantly initiate short‐acting opioids in accordance with Center for Disease Control and Prevention guidelines. Documented variation by geographic and resident characteristics suggests that improvements are possible.