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- Title
Primary Care Opioid Taper Plans Are Associated with Sustained Opioid Dose Reduction.
- Authors
D. Sullivan, Mark; Boudreau, Denise; Ichikawa, Laura; Cronkite, David; Albertson-Junkans, Ladia; Salgado, Gladys; VonKorff, Michael; Carrell, David S.
- Abstract
<bold>Background: </bold>Primary care providers prescribe most long-term opioid therapy and are increasingly asked to taper the opioid doses of these patients to safer levels. A recent systematic review suggests that multiple interventions may facilitate opioid taper, but many of these are not feasible within the usual primary care practice.<bold>Objective: </bold>To determine if opioid taper plans documented by primary care providers in the electronic health record are associated with significant and sustained opioid dose reductions among patients on long-term opioid therapy.<bold>Design: </bold>A nested case-control design was used to compare cases (patients with a sustained opioid taper defined as average daily opioid dose of ≤ 30 mg morphine equivalent (MME) or a 50% reduction in MME) to controls (patients matched to cases on year and quarter of cohort entry, sex, and age group, who had not achieved a sustained taper). Each case was matched with four controls.<bold>Participants: </bold>Two thousand four hundred nine patients receiving a ≥ 60-day supply of opioids with an average daily dose of ≥ 50 MME during 2011-2015.<bold>Main Measures: </bold>Opioid taper plans documented in prescription instructions or clinical notes within the electronic health record identified through natural language processing; opioid dosing, patient characteristics, and taper plan components also abstracted from the electronic health record.<bold>Key Results: </bold>Primary care taper plans were associated with an increased likelihood of sustained opioid taper after adjusting for all patient covariates and near peak dose (OR = 3.63 [95% CI 2.96-4.46], p < 0.0001). Both taper plans in prescription instructions (OR = 4.03 [95% CI 3.19-5.09], p < 0.0001) and in clinical notes (OR = 2.82 [95% CI 2.00-3.99], p < 0.0001) were associated with sustained taper.<bold>Conclusions: </bold>These results suggest that planning for opioid taper during primary care visits may facilitate significant and sustained opioid dose reduction.
- Subjects
PRIMARY care; MEDICAL personnel; OPIOIDS; ELECTRONIC health records; NATURAL language processing
- Publication
JGIM: Journal of General Internal Medicine, 2020, Vol 35, Issue 3, p687
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-019-05445-1