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- Title
Patterns of Opioid Prescribing among Medicare Advantage Beneficiaries with Pain and Cardiopulmonary Conditions.
- Authors
Feder, Shelli L.; Canavan, Maureen E.; Wang, Shiyi; Kent, Erin E.; Kapo, Jennifer; Presley, Carolyn J.; Ross, Joseph; Davidoff, Amy J.
- Abstract
Background: Pain is common among patients with cardiopulmonary conditions; however, there are increasing concerns, but limited research, regarding use of opioids for pain in patients with noncancer conditions. Objective: To compare patterns of opioid prescribing among older adults reporting pain with cardiopulmonary conditions and/or cancer. Design: Observational study using data from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey resource linked to Medicare Part D prescription claims. Setting/Subjects: We identified patients who self-reported moderate-to-severe pain interference with daily activities. Patients were stratified by (1) self-reported history of cardiopulmonary conditions; (2) were within five years of cancer diagnosis; (3) had both conditions; or (4) neither. Measurements: We characterized opioid prescribing within 30 days of survey and one-year follow-up using logistic regression and Cox proportional hazard time-to-event analyses. Results: Of 10,516 patients with moderate-to-severe pain (1758 cardiopulmonary conditions, 3383 cancer, 2861 both, 2514 neither), 46% were aged ≥75 years, 65% were non-Hispanic white, and 10% non-Hispanic black. At survey, 1627 (15.5%) received opioids. Adjusted proportions of opioid use were lower for patients with cardiopulmonary conditions only (14%) compared with cancer only (17%; p < 0.001) and both conditions (17%; p < 0.001) but higher than patients with neither condition (13.1%; p < 0.001). There was no difference in time to initiation of opioids at follow-up among patients with cardiopulmonary conditions only, relative to cancer only (adjusted hazard ratio 1.03; 95% confidence interval 0.88–1.21). Conclusions: Opioid use is lower among patients with pain and cardiopulmonary conditions relative to patients with cancer. Findings emphasize the importance of pain assessment and management for patients with cardiopulmonary conditions.
- Subjects
TUMOR diagnosis; THERAPEUTIC use of narcotics; ANALGESICS; CHI-squared test; CONFIDENCE intervals; PULMONARY heart disease; DRUG prescribing; MEDICARE; NARCOTICS; SCIENTIFIC observation; PAIN; T-test (Statistics); PHYSICIAN practice patterns; DATA analysis software; DESCRIPTIVE statistics
- Publication
Journal of Palliative Medicine, 2021, Vol 24, Issue 2, p195
- ISSN
1096-6218
- Publication type
Article
- DOI
10.1089/jpm.2020.0193