Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA.
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Pharmacoepidemiol Drug Saf. 2020 Sep;29(9):1183-1188. doi: 10.1002/pds.5075. Epub 2020 Jul 29.
Skilled nursing facility (SNF) residents are at increased risk for opioid-related harms. We quantified the frequency of opioid prescribing among patients discharged from an acute care hospital to SNFs.
This was a retrospective cohort study among adult (≥18 years) inpatients discharged from a quaternary-care academic referral hospital in Portland, OR to a SNF between January 1, 2017 and December 31, 2018. Our primary outcome was receipt of an opioid prescription on discharge to a SNF. Our exposures included patient demographics (eg, age, sex), comorbid illnesses, surgical diagnosis related group (DRG), receiving opioids on the first day of the index hospital admission, and inpatient hospital length of stay.
Among 4374 patients discharged to a SNF, 3053 patients (70%) were prescribed an opioid on discharge. Among patients prescribed an opioid, 61% were over the age of 65 years, 50% were male, and 58% had a surgical Medicare severity diagnosis related group (MS-DRG). Approximately 70% of patients discharged to a SNF were prescribed an opioid on discharge, of which 68% were for oxycodone, and 52% were for ≥90 morphine milligram equivalents per day. Surgical DRG, diagnoses of cancer or chronic pain, last pain score, and receipt of an opioid on first day of the index hospital admission were independently associated with being prescribed an opioid on discharge to a SNF.
Opioids were frequently prescribed at high doses to patients discharged to a SNF. Efforts to improve opioid prescribing safety during this transition may be warranted.
疗养院（SNF）居民面临更高的阿片类药物相关危害风险。我们量化了从急性护理医院出院到 SNF 的患者开具阿片类药物的频率。
这是一项回顾性队列研究，纳入了 2017 年 1 月 1 日至 2018 年 12 月 31 日期间从俄勒冈州波特兰市的一家四级保健学术转诊医院出院到 SNF 的成年（≥18 岁）住院患者。我们的主要结局是在出院到 SNF 时收到阿片类药物处方。我们的暴露因素包括患者人口统计学特征（如年龄、性别）、合并症、手术诊断相关组（DRG）、在入院的第一天接受阿片类药物治疗，以及住院期间的住院时间。
在 4374 名出院到 SNF 的患者中，有 3053 名（70%）患者在出院时被开具了阿片类药物处方。在开具阿片类药物处方的患者中，61%的患者年龄超过 65 岁，50%的患者为男性，58%的患者患有手术医疗保险严重程度诊断相关组（MS-DRG）。大约 70%出院到 SNF 的患者在出院时被开具了阿片类药物处方，其中 68%为羟考酮，52%为≥90 吗啡毫克当量/天。出院到 SNF 时开具阿片类药物处方与手术 DRG、癌症或慢性疼痛诊断、最后疼痛评分以及在入院的第一天接受阿片类药物治疗有关。
在出院到 SNF 的患者中，经常开具高剂量的阿片类药物。在这一过渡期间，可能需要努力提高阿片类药物处方的安全性。
