Opioid use in long-term care settings: final report
- Collection:
- Health Policy and Services Research
- Author(s):
- Stevenson, David G. (David George), author Cheng, Audrey, (Of Vanderbilt University School of Medicine), author Huskamp, Haiden A., author
- Contributor(s):
- United States. Department of Health and Human Services. Office of Behavioral Health, Disability, and Aging Policy, issuing body. Vanderbilt University. School of Medicine, issuing body.
- Publication:
- [Washington, D.C.] : Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office Of Behavioral Health, Disability, and Aging Policy, August 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Analgesics, Opioid -- therapeutic use Inappropriate Prescribing Long-Term Care Nursing Homes United States
- Genre(s):
- Technical Report
- Abstract:
- Using pharmacy claims data from IQVIA, this project tracked the use of pain medications across retail and long-term care (LTC) pharmacy settings. IQVIA data cover a large portion of these pharmacy markets nationally and capture prescription drug claims across payers, including medications covered through Medicare’s bundled skilled nursing facility (SNF) payments. Our study findings are based on a sample of individuals aged 65 and above who were admitted to LTC (a category that includes nursing homes (SNFs and nursing facilities [NFs]) and assisted living facilities) and received opioid or non-opioid pain medications there between July 1, 2018, and June 30, 2019. Around three-quarters of our study sample had at least one opioid prescription during their initial LTC stay. The vast majority (83%) was opioid “naïve” before their LTC admission. This proportion differed considerably depending on whether individuals remained in the LTC setting during our study period or were discharged back to the community, presumably following a post-acute SNF stay. Twenty-nine percent (29%) of discharged residents had opioid use in the 45 days before their LTC admission, compared to only 10% of residents who remained in the LTC facility. This difference could reflect conditions that more typically result in post-acute SNF stays, including procedures that may be precipitated by pain that is difficult to manage. Although most discharged residents had opioid use in the first three days in the LTC setting, many of these individuals were no longer taking opioids by the end of their stay. This pattern was different for residents who were not discharged and remained in the facility for longer stays. Relative to discharged residents, opioid use for non-discharged residents was generally lower during the first three days in the LTC facility; this use declined only modestly for these residents by day 30 of the LTC stay. Among the roughly one-third of residents in our sample who had benzodiazepine use, almost all had concurrent use of an opioid and a benzodiazepine during their LTC stay, despite the U.S. Department of Health and Human Services (HHS) Centers for Disease Control and Prevention (CDC) 2016 guidelines advising against this practice. Around one-fourth of all discharged individuals (26%) had a retail claim for opioids within seven days of discharge, something that was relatively common for those with opioid use during the last three days of the LTC stay. A sizeable minority of discharged individuals had longer-term or chronic opioid use during the post-discharge period. Among those who had retail claims only during the 180 days following LTC discharge, 16% had at least 90 days supply of opioids during their first 180 days in the community. In sum, opioid use was very common among the LTC residents in our sample. Perhaps reflecting their post-acute rehabilitative needs, discharged residents were more likely to have opioid use prior to LTC admission and at the beginning of the LTC stay. Opioid use diminished over the course of the LTC stay for this group, but a sizeable minority of these individuals still had opioid use once discharged to the community, some of which developed into longer-term or chronic use. The non-discharged individuals in our sample generally had lower opioid use prior to LTC admission and at the beginning of the LTC stay. Over the course of their LTC stay, however, opioid use by non-discharged residents dropped only modestly, sometimes with problematic benzodiazepine use added to their medications.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (vi, 31 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918574080106676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918574080106676