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    Long-acting opioid initiation in US nursing homes

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    Authors
    Hunnicutt, Jacob N.
    Hume, Anne L.
    Ulbricht, Christine M.
    Tjia, Jennifer
    Lapane, Kate L.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2018-06-04
    Keywords
    long-acting opioids
    long-term care
    nursing homes
    pharmacoepidemiology
    prescription opioids
    Epidemiology
    Geriatrics
    Health Services Administration
    Health Services Research
    Medical Pharmacology
    Pharmaceutical Preparations
    Pharmacy and Pharmaceutical Sciences
    Therapeutics
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    Link to Full Text
    https://doi.org/10.1002/pds.4568
    Abstract
    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.
    Source

    Pharmacoepidemiol Drug Saf. 2018 Jun 4. doi: 10.1002/pds.4568. [Epub ahead of print] Link to article on publisher's site

    DOI
    10.1002/pds.4568
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/46745
    PubMed ID
    29869441
    Related Resources

    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1002/pds.4568
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    Population and Quantitative Health Sciences Publications

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