Article Figures & Data
Tables
- Table 1
Demographic Distribution of Patients With Long-Term Use of Stimulants, Opioids, or Benzodiazepines
Characteristic Stimulants No. (%) Opioids No. (%) Benzodiazepines No. (%) Total No. 9,014 78,056 31,437 Age, y 18-44 4,648 (51.6) 13,850 (17.7) 5,972 (19.0) 45-54 1,888 (21.0) 17,724 (22.7) 7,257 (23.1) 55-64 1,807 (20.1) 24,371 (31.2) 9,858 (31.4) ≥65 671 (7.4) 22,111 (28.3) 8,350 (26.6) Locationa Urban 6,541 (72.6) 43,696 (56.0) 18,547 (59.0) Rural 2,317 (25.7) 32,949 (42.2) 12,454 (39.6) ↵a Excludes 1,411 (1.8%) non-Oregon and unknown patients with long-term use of opioids, 156 (1.7%) stimulants, and 436 (1.4%) benzodiazepines.
- Table 2
Long-Term Opioid-Use Patients With Risky Opioid Prescriptions or Opioid Harms in Each Continuity of Care Index Quartile
Characteristic Total Continuity of Care Indexa P Value Quartile 1 Quartile 2 Quartile 3 Quartile 4 Quartile index score, range 0.005-1.00 0.005-0.411 0.412-0.639 0.640-0.855 0.856–1.000 Number of patients 78,056 19,510 19,518 19,471 19,557 High-dose opioid, No. (%) 29,063 (37.2) 7,944 (40.7) 7,194 (36.9) 6,958 (35.7) 6,967 (35.6) <.0001 Opioid-benzodiazepine overlap, No. (%) 43,884 (56.2) 12,364 (63.4) 11,154 (57.2) 10,572 (54.3) 9,794 (50.1) <.0001 Long-acting opioid, No. (%) 36,149 (46.6) 10,549 (54.1) 9,242 (47.4) 8,529 (43.8) 7,829 (40.0) <.0001 Using ≥4 opioid prescribers, No. (%) 23,488 (30.1) 12,799 (65.6) 7,049 (36.1) 3,436 (17.7) 204 (1.0) <.0001 Inappropriate opioid prescription, No. (%) 19,395 (24.9) 8,246 (42.3) 5,322 (27.3) 4,258 (21.9) 1,569 (8.0) <.0001 Any opioid hospitalization, No. (%) 3,034 (3.9) 1,122 (5.8) 835 (4.3) 674 (3.5) 403 (2.1) <.0001 Opioid overdose death, No. (%) 22 (0.0) 6 (0.0) 6 (0.0) 6 (0.0) 4 (0.0) .2828 ↵a Quartiles divided into lowest continuity (Q1) to highest continuity (Q4) index scores.
Additional Files
The Article in Brief
Opioid-Prescribing Continuity and Risky Opioid Prescriptions
Sara E. Hallvik , and colleagues
Background In an effort to reduce risks associated with taking opioids, clinical guidelines often emphasize continuity between patients and opioid prescribers. This study aims to better understand the association between opioid prescribing continuity, risky prescribing patterns, and overdose risk.
What This Study Found An ongoing relationship between patients with long-term opioid use and the doctors who prescribe the medication is associated with fewer risky opioid prescriptions and fewer opioid-related hospitalizations. This retrospective cohort study analyzed data from Oregon"s Prescription Drug Monitoring Program, Vital Statistics, and hospital discharge registry for more than 78,000 patients with long-term opioid use. Patients with higher continuity with the physician prescribing opioids received fewer risky prescriptions (based on multiple prescriber metrics) compared to patients in the lowest continuity quartile, and were less likely to be hospitalized for opioid-related causes. However, on average, patients with long-term opioid use had significantly lower continuity scores than patients with long-term use of a stimulant or benzodiazepine, suggesting that efforts are still needed to improve opioid prescribing continuity.
Implications
- This study, which adds to the limited literature on prescriber continuity and opioids, suggests that continuity with the prescribing physician is an important factor associated with reducing opioid harms.
The Article in Brief
Top 20 POEMs of the Past 20 Years: A Survey of Practice-Changing Research for Family Physicians
Mark H. Ebell , and colleagues
Background POEMs (Patient Oriented Evidence that Matters) are studies that address a relevant clinical question, demonstrate improved patient-oriented outcomes, and have the potential to change practice. This report identifies POEMs in each of the last 20 years that were highest ranked by the originators of POEMs for having recommended a major and persistent change in practice.
What This Study Found POEMs have recommended novel effective interventions (e.g., beta-blockers in heart failure and a longer interval between Pap smears for most women), abandoning ineffective practices (e.g., routinely recommending hormone replacement therapy for postmenopausal women), and abandoning potentially harmful practices (e.g., intensive blood sugar control for patients with type 2 diabetes mellitus and aggressive therapy for low-grade prostate cancer).
Implications
- These POEMs illustrate the breadth of practice change in primary care and the need for family physicians to have a systematic approach to keeping up with the medical literature.
