192K EMRs Suggest Link Between Inpatient and Outpatient Opioid Use

Patients who didn’t wean off opioids were more likely to obtain a prescription after discharge.

Image has been cropped and resized. Credit: ATS.

In what’s being promoted as a novel study, researchers from the University of Pittsburgh School of Medicine have found that patients who received opioids in the hospital were more than twice as likely to use opioids within 90 days of discharge.

The finding is just one of several to come from an analysis of 357,413 electronic medical records (EMRs), from 2010 to 2014, in University of Pittsburgh Medical Center hospitals, which serve a population that has been hit hard by the opioid epidemic.

The researchers claimed that this large-scale study is among the first to examine how inpatient clinical decisions involving opioids affect use after a patient is discharged. Taken together, the findings could one day help clinicians and healthcare organizations take a more proactive stance against the deadly and widespread opioid crisis.

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“Reducing use of opiates near the end of a hospital stay, especially in the 24 hours before discharge, may reduce outpatient prescription of opioids,” Jason Kennedy, MS, the study’s lead author and research project manager for the school’s Department of Critical Care Medicine. “Weaning [intensive care unit] ICU patients off of intravenous opioids, the most potent way of administering these pain killers, before transitioning them to the medical ward may also help reduce outpatient usage.”

Kennedy’s recommendations are rooted in the study’s major findings. The primary takeaway, for instance, showed that 8.4% of patients who received an opioid during their hospital visit reported post-discharge use, compared to 4.1% of other patients.

What’s more, patients who used opioids for more than 75% of their stay were 32% more likely than those who took opioids for less than 25% of their stay to receive a post-discharge prescription after exiting the hospital.

People who took opioids within 12 hours before leaving the hospital, meanwhile, were 2 times more likely to get a post-discharge prescription than patients who quit taking opioids 24 hours before they left the hospital. In that vein, 33% of patients received some sort of opioid during their final day in the hospital.

Finally, 20% of ICU patients who took opioids went on to receive intravenous opioids after heading to the medical ward, according to the study.

Kennedy said the study could result in effective changes to inpatient opioid prescribing policies since most studies have focused on outpatient settings.

“But opioids are often introduced during hospitalization,” he said. “That’s something clinicians can control, so we looked at inpatient prescription of these drugs to identify targets that may reduce opioid use once patients are out of the hospital.”

That sense of clinician control is important, but they will need to better understand exactly how, and how often, they prescribe opioids in the first place. A study out of the University of Colorado earlier this year, for example, suggested that 65% of emergency department physicians underestimate the number of opioid prescriptions they write.

Still, the Pittsburgh research team called for additional study featuring randomized, controlled trials, if healthcare is to pin down concrete guidelines for providers.

Also of note here is how researchers leveraged the power of the EMR to reach their conclusions. Of the 357,000 patients whose records they analyzed, 192,240 had not received an opioid in the year running up to their hospital stay. Researchers focused on those individuals, whose EMRs provided a trove of information.

The resultant study, “Patterns of Inpatient, Intensive Care, and Post-Discharge Opioid Prescribing to Opioid-Naïve Patients in a Large Health System,” was recently published in the American Journal of Respiratory and Critical Care Medicine.

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