National opioid prescribing trends in emergency departments by provider type: 2005-2015

被引:16
作者
Yang, Bo Kyum [1 ]
Storr, Carla L. [2 ]
Trinkoff, Alison M. [2 ]
Sohn, Minji [3 ]
Idzik, Shannon K. [4 ]
McKinnon, Mark [1 ]
机构
[1] Towson Univ, Coll Hlth Profess, Dept Hlth Sci, Towson, MD 21252 USA
[2] Univ Maryland, Sch Nursing, Dept Family & Community Hlth, Baltimore, MD 21201 USA
[3] Ferris State Univ, Coll Pharm, Dept Pharmaceut Sci, Big Rapids, MI USA
[4] Univ Maryland, Sch Nursing, Dept Org Syst & Adult Hlth, Baltimore, MD 21201 USA
关键词
Nurse practitioner; Physician assistant; Physician; Opioid prescribing; Emergency department; NURSE-PRACTITIONERS; PHYSICIAN ASSISTANTS; UNITED-STATES; CHRONIC PAIN; US;
D O I
10.1016/j.ajem.2018.10.041
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: To describe opioid prescribing practice patterns and trends in emergency department visits (EDs) by provider type: physicians and advanced practice providers (APPS), which include nurse practitioners (NPs) and physician assistants (PAs). Methods: The data source was the ED visit files of the 2005-2015 National Hospital Ambulatory Care Survey. The study sample was opioid prescription-related ED visits. Descriptive and multinomial logistic regression analyses were conducted to assess the proportion of opioid prescription-related visits by provider type over time in total and by patient age group. We then characterized opioid prescribing practices of NPs, PAs, and physicians according to type of opioid and pain-related diagnosis. Results: From 2005 to 2015, there was a 116.7% increase in the proportion of the opioid prescription-related visits seen by NPs and a 61.2% increase seen by both APPS and physicians. In contrast, the proportion of the physician only visits decreased (-8.3%). When stratified by age group, the growth was particularly notable among the visits with patients aged 65 and older seen by both APPS and physicians (AOR = 2.35, 95% CI = 1.69, 3.25). Proportionally less hydromorphone and morphine was prescribed by APPS than by physicians. Opioids were prescribed more often by APPS in visits involving dental and injury-related pain, whereas physicians prescribed opioids more in abdominal and chest pain-related visits. Conclusions: From 2005 to 2015, APPS, particularly NPs played an increasing role in opioid prescribing in EDs.Opioicl prescribing practices of APPS and physicians varied by patient condition as well as by opioicl type. (C) 2018 Elsevier Inc. All rights reserved.
引用
收藏
页码:1439 / 1445
页数:7
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