Furuno Jon P, Noble Brie N, Fromme Erik K, Hartung Daniel M, Tjia Jennifer, Lynn Mary, Teno Joan M
Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA.
Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA.
J Pain Symptom Manage. 2021 Nov;62(5):1026-1033. doi: 10.1016/j.jpainsymman.2021.03.025. Epub 2021 Apr 10.
There are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life.
We assessed trends in opioid prescribing among patients on discharge from the hospital to hospice care.
This was a retrospective cohort study among adult (age ≥18 years) patients discharged from a 544-576 bed, academic medical center to hospice care between January 1, 2010 to December 31, 2018. Study data were collected from a repository of patients' electronic health record data. Our primary outcome was the frequency of opioid prescribing on discharge to hospice care. Our primary exposure was the calendar year of discharge. We also investigated non-opioid analgesic prescribing and stratified opioid prescribing trends by patient characteristics (e.g., demographics, cancer diagnosis, and location of hospice care).
Among 2,648 discharges to hospice care, mean (standard deviation) age was 65.8 (16.0) years, 46.3% were female, and 58.7% had a cancer diagnosis. Opioid prescribing on discharge to hospice care decreased significantly from 91.2% (95% confidence interval (CI) = 87.1%-94.1%) in 2010 to 79.3% (95% CI = 74.3%-83.5%) in 2018 adjusting for age, sex, cancer diagnosis, and location of hospice care. Prescribing of non-opioid analgesic medications increased over the same time period.
We observed a statistically significant decreasing trend in opioid prescribing on discharge to hospice care. Further research should aim to confirm these findings and to identify opportunities to ensure optimal pain management among patients transitioning to hospice care.
有人担心旨在预防阿片类药物滥用的政策可能会无意中减少临终患者获得阿片类药物的机会。
我们评估了从医院出院转至临终关怀的患者中阿片类药物处方的趋势。
这是一项回顾性队列研究，研究对象为2010年1月1日至2018年12月31日期间从一家拥有544 - 576张床位的学术医疗中心出院转至临终关怀的成年（年龄≥18岁）患者。研究数据从患者电子健康记录数据库中收集。我们的主要结局是出院转至临终关怀时阿片类药物处方的频率。我们的主要暴露因素是出院年份。我们还调查了非阿片类镇痛药的处方情况，并按患者特征（如人口统计学特征、癌症诊断和临终关怀地点）对阿片类药物处方趋势进行分层。
在2648例出院转至临终关怀的患者中，平均（标准差）年龄为65.8（16.0）岁，46.3%为女性，58.7%有癌症诊断。在调整年龄、性别、癌症诊断和临终关怀地点后，出院转至临终关怀时的阿片类药物处方率从2010年的91.2%（95%置信区间（CI）=87.1% - 94.1%）显著下降至2018年的79.3%（95%CI =74.3% - 83.5%）。在同一时期，非阿片类镇痛药物的处方量有所增加。
我们观察到出院转至临终关怀时阿片类药物处方存在统计学上的显著下降趋势。进一步的研究应旨在证实这些发现，并确定机会以确保向临终关怀过渡的患者得到最佳疼痛管理。
