Inappropriate Fentanyl Prescribing Among Nursing Home Residents in the United States

被引：16

作者：

Fain, Kevin M. ^{[1
,2
]}

Castillo-Salgado, Carlos ^{[1
]}

Dore, David D. ^{[3
,4
]}

Segal, Jodi B. ^{[2
,5
,6
]}

Zullo, Andrew R. ^{[4
]}

Alexander, G. Caleb ^{[1
,2
,6
]}

机构：

[1] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, 615 N Wolfe St,W6508, Baltimore, MD 21205 USA

[2] Johns Hopkins Bloomberg Sch Publ Hlth, Ctr Drug Safety & Effectiveness, Baltimore, MD USA

[3] Optum Epidemiol, Waltham, MA USA

[4] Brown Univ, Dept Hlth Serv Policy & Practice, Sch Publ Hlth, Providence, RI 02912 USA

[5] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA

[6] Johns Hopkins Med, Dept Med, Baltimore, MD USA

来源：

JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION | 2017年 / 18卷 / 02期

基金：

美国医疗保健研究与质量局;

关键词：

Nursing homes; fentanyl; prescription opioids; Food and Drug Administration; ADVERSE DRUG EVENTS; QUALITY-OF-CARE; PHARMACOLOGICAL MANAGEMENT; RACIAL/ETHNIC DISPARITIES; PAIN MANAGEMENT; PROVIDERS; HEALTH; FOOD;

D O I：

10.1016/j.jamda.2016.08.015

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Objective: We quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naive prescribing. Design: Cross-sectional study. Setting: Linked Minimum Data Set (MDS) assessments; Online Survey, Certification and Reporting (OSCAR) records; and Medicare Part D claims. Participants: From a cross-section of all long-stay US nursing home residents in 2008 with an MDS assessment and Medicare Part D enrollment, we identified individuals (>= 65 years old) who initiated transdermal fentanyl, excluding those with Alzheimer disease, severe cognitive impairment, cancer, or receipt of hospice care. Measurements: We used Medicare Part D to select beneficiaries initiating transdermal fentanyl in 2008 and determined whether they were "opioid-naive," defined as no opioid dispensing during the previous 60 days. We obtained resident and facility characteristics from MDS and OSCAR records and defined persistent pain as moderate-to-severe, daily pain on consecutive MDS assessments at least 90 days apart. We estimated associations of patient and facility attributes and opioid-naive fentanyl initiation using multilevel mixed effects logistic regression modeling. Results: Among 17,052 residents initiating transdermal fentanyl, 6190 (36.3%) were opioid-naive and 15,659 (91.8%) did not have persistent pain. In the regression analysis with adjustments, residents who were older (ages >= 95 odds ratio [OR] 1.69, 95% confidence interval [CI] 1.46-1.95) or more cognitively impaired (moderate-to-severe cognitive impairment, OR 1.99, 95% CI 1.73-2.29) were more likely to initiate transdermal fentanyl without prior opioid use. Conclusion: Most nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naive. Changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

引用

页码：138 / 144

页数：7

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