Assessing the Appropriateness of Opioid Prescribing in Elderly Nursing Home Residents

Nursing Homes;Persistent Pain;Prescription Opioids;Food and Drug Administration;Epidemiology

Fain, KevinDiener-West, Marie ;

Johns Hopkins University

关键词: Nursing Homes;    Persistent Pain;    Prescription Opioids;    Food and Drug Administration;    Epidemiology;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39530/FAIN-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Background:Untreated persistent pain causes much hardship for elderly nursing home residents.Analgesic prescribing can be critical to alleviate this pain, but inappropriate opioid prescribing can create serious health risks for residents. Objectives: This dissertation examined the lack of analgesic prescribing for elderly nursing home residents in persistent pain, as well as opioid prescribing deviating from Food and Drug Administration (FDA) conditions, and identified those factors associated with no analgesic prescribing and inappropriate opioid prescribing.Methods:Our study population is from a cross-section of all long-stay U.S. nursing home residents ≥65 years in 2008 with a Minimum Data Set assessment and Medicare Part D enrollment.Using these records, we quantified no analgesic prescribing for residents with persistent pain (aim one); inappropriate transdermal fentanyl initiation, i.e., without prior opioid use (;;opioid-naïve”) or no persistent pain (aim two); and inappropriate oxycodone extended-release (ER) co-prescribing, i.e., with any central nervous system (CNS) depressant (aim three).We estimated associations of patient and facility attributes with these outcomes using multilevel mixed effects logistic regression analyses.Results: We found 16.7% of residents with persistent pain did not receive a prescription analgesic (aim one); 36.3% of residents initiating transdermal fentanyl were opioid-naïve and 91.8% did not have persistent pain (aim two); and 26.6% of residents were co-prescribed a CNS depressant with oxycodone ER (aim three).Residents who were older or more cognitively impaired were less likely to receive a prescription analgesic (aim one); more likely to be opioid-naïve when initiating transdermal fentanyl (aim two); and less likely to be co-prescribed two or more CNS depressants with oxycodone ER (aim three). Conclusion:Pain remains incompletely treated in U.S. nursing homes, especially among certain subpopulations, such as residents with greater cognitive impairment and older age.There are also substantial deviations in nursing homes from FDA conditions for safe use of long-acting opioids.FDA should take action to communicate these risks to nursing homes and ensure proper use, including through the long-acting opioid Risk Evaluation and Mitigation Strategy (REMS).Nursing homes should take steps to ensure appropriate long-acting opioid prescribing, particularly for residents without prior opioid use or persistent pain.