Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain
Objective: To determine associations between post-emergency department (ED) management pathways and downstream opioid prescriptions in patients seeking care for incident neck and/or back pain. Patients and Methods: We identified patients seeking first-time ED care for neck and/or back pain from Janu...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-10-01
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| Series: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S254245482300053X |
| _version_ | 1797653922082455552 |
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| author | Maggie E. Horn, DPT, MPH, PhD Corey B. Simon, DPT, PhD Hui-Jie Lee, PhD Stephanie A. Eucker, MD, PhD |
| author_facet | Maggie E. Horn, DPT, MPH, PhD Corey B. Simon, DPT, PhD Hui-Jie Lee, PhD Stephanie A. Eucker, MD, PhD |
| author_sort | Maggie E. Horn, DPT, MPH, PhD |
| collection | DOAJ |
| description | Objective: To determine associations between post-emergency department (ED) management pathways and downstream opioid prescriptions in patients seeking care for incident neck and/or back pain. Patients and Methods: We identified patients seeking first-time ED care for neck and/or back pain from January 1, 2013, through November 6, 2017. We reported demographic characteristics and opioid prescriptions across management pathways using descriptive statistics and assessed the relative risk of any opioid prescription 12 months post-ED visit among 5 different post-ED management pathways using Poisson regression adjusted for patient demographic characteristics. Results: Within 12 months after the index ED visit, 58.0% (n=10,949) were prescribed an opioid, with most patients prescribed an opioid within the first week (average daily morphine milligram equivalents of 6.8 mg (SD 9.6 mg). The morphine milligram equivalents decreased to 0.7 mg (SD 8.2 mg) by week 4 and remained consistently less than 1 mg between week 4 and 12 months. Compared with the ED to primary care provider pathway, the relative risk of opioid prescription between 7 days and 12 months after the index ED visit was similar for the ED to physical therapy pathway, higher for both the ED to hospital admission or repeat ED visit pathway (30% increase; relative risk (RR), 1.3; 95% CI, 1.17-1.44) and the ED to specialist pathway (19% increase; RR, 1.19; 95% CI, 1.07-1.33), and lower in the ED with no follow-up visits pathway (41% decrease; RR, 0.59; 95% CI, 0.54-0.65). Conclusion: In general, more conservative care was associated with lower opioid prescription rates, and escalated care was associated with higher opioid prescription rates. |
| first_indexed | 2024-03-11T16:51:50Z |
| format | Article |
| id | doaj.art-e3bca47691ff4a86a0e08c179812db60 |
| institution | Directory Open Access Journal |
| issn | 2542-4548 |
| language | English |
| last_indexed | 2024-03-11T16:51:50Z |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| spelling | doaj.art-e3bca47691ff4a86a0e08c179812db602023-10-21T04:23:06ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482023-10-0175490498Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back PainMaggie E. Horn, DPT, MPH, PhD0Corey B. Simon, DPT, PhD1Hui-Jie Lee, PhD2Stephanie A. Eucker, MD, PhD3Department of Orthopaedic Surgery, Division of Physical Therapy, Duke University, Durham, NC; Department of Population Health Sciences, Duke University, Durham, NC; Correspondence: Address to Maggie E. Horn, Duke University, Box 10042, Durham, NC 27710.Department of Orthopaedic Surgery, Division of Physical Therapy, Duke University, Durham, NCDepartment of Biostatistics and Bioinformatics, Duke University, Durham, NCDepartment of Emergency Medicine, Duke University, Durham, NCObjective: To determine associations between post-emergency department (ED) management pathways and downstream opioid prescriptions in patients seeking care for incident neck and/or back pain. Patients and Methods: We identified patients seeking first-time ED care for neck and/or back pain from January 1, 2013, through November 6, 2017. We reported demographic characteristics and opioid prescriptions across management pathways using descriptive statistics and assessed the relative risk of any opioid prescription 12 months post-ED visit among 5 different post-ED management pathways using Poisson regression adjusted for patient demographic characteristics. Results: Within 12 months after the index ED visit, 58.0% (n=10,949) were prescribed an opioid, with most patients prescribed an opioid within the first week (average daily morphine milligram equivalents of 6.8 mg (SD 9.6 mg). The morphine milligram equivalents decreased to 0.7 mg (SD 8.2 mg) by week 4 and remained consistently less than 1 mg between week 4 and 12 months. Compared with the ED to primary care provider pathway, the relative risk of opioid prescription between 7 days and 12 months after the index ED visit was similar for the ED to physical therapy pathway, higher for both the ED to hospital admission or repeat ED visit pathway (30% increase; relative risk (RR), 1.3; 95% CI, 1.17-1.44) and the ED to specialist pathway (19% increase; RR, 1.19; 95% CI, 1.07-1.33), and lower in the ED with no follow-up visits pathway (41% decrease; RR, 0.59; 95% CI, 0.54-0.65). Conclusion: In general, more conservative care was associated with lower opioid prescription rates, and escalated care was associated with higher opioid prescription rates.http://www.sciencedirect.com/science/article/pii/S254245482300053X |
| spellingShingle | Maggie E. Horn, DPT, MPH, PhD Corey B. Simon, DPT, PhD Hui-Jie Lee, PhD Stephanie A. Eucker, MD, PhD Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| title | Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain |
| title_full | Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain |
| title_fullStr | Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain |
| title_full_unstemmed | Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain |
| title_short | Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain |
| title_sort | associations between management pathway and opioid prescriptions for patients entering the emergency department with neck and back pain |
| url | http://www.sciencedirect.com/science/article/pii/S254245482300053X |
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