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Impact of initiatives to reduce prescription opioid risks on medically attended injuries in people using chronic opioid therapy
Author(s) -
Dublin Sascha,
Walker Rod L.,
Shortreed Susan M.,
Ludman Evette J.,
Sherman Karen J.,
Hansen Ryan N.,
Thakral Manu,
Saunders Kathleen,
Parchman Michael L.,
Von Korff Michael
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.4678
Subject(s) - medicine , rate ratio , poisson regression , emergency medicine , medical prescription , interrupted time series analysis , relative risk , pharmacoepidemiology , incidence (geometry) , injury prevention , interrupted time series , opioid , health care , occupational safety and health , confidence interval , poison control , environmental health , psychological intervention , population , psychiatry , nursing , mathematics , economic growth , receptor , pathology , optics , statistics , physics , economics
Purpose The purpose of the study is to determine whether initiatives to improve the safety of opioid prescribing decreased injuries in people using chronic opioid therapy (COT). Methods We conducted an interrupted time series analysis using data from Group Health (GH), an integrated health care delivery system in the United States. In 2007, GH implemented initiatives which substantially reduced daily opioid dose and increased patient monitoring. Among GH members age 18 or older receiving COT between 2006 and 2014, we compared injury rates for patients in GH's integrated group practice (IGP; exposed to the initiatives) vs patients cared for by contracted providers (not exposed). Injuries were identified using a validated algorithm. We calculated injury incidence during the baseline (preintervention) period from 2006 to 2007; the dose reduction period, 2008 to 2010; and the risk stratification and monitoring period, 2010 to 2014. Using modified Poisson regression, we estimated adjusted relative risks (RRs) representing the relative change per year in injury rates. Results Among 21 853 people receiving COT in the IGP and 8260 in contracted care, there were 2679 injuries during follow‐up. The baseline injury rate was 1.0% per calendar quarter in the IGP and 0.9% in contracted care. Risk reduction initiatives did not decrease injury rates: Within the IGP, the RR in the dose reduction period was 1.01 (95% CI, 0.95‐1.07) and in the risk stratification and monitoring period, 0.99 (95% CI, 0.95‐1.04). Injury trends did not differ between the two care settings. Conclusions Risk reduction initiatives did not decrease injuries in people using COT.