From: Quality of opioid prescribing in older adults with or without Alzheimer disease and related dementia
Quality indicators of inappropriate opioid prescribinga | Community | P-value | Nursing home | P-value | ||||
---|---|---|---|---|---|---|---|---|
Weighted proportion among patients with ADRD, % | Weighted proportion among patients without ADRD, % | Proportion difference (95% CI)b | Weighted proportion among patients with ADRD, % | Weighted proportion among patients without ADRD, % | Proportion difference (95% CI)b | |||
Use of opioids contraindicated for older adults with chronic pain | ||||||||
Use of meperidine, propoxyphene or partial or mixed opioid agonsists | 0.08 | 0.12 | − 0.04 (− 0.06 to − 0.01) | < .001 | 0.05 | 0.21 | − 0.2 (− 0.3 to − 0.03) | < .001 |
Opioid prescribing for opioid-naive patients | ||||||||
Use of long-acting opioid | 0.49 | 0.62 | − 0.13 (− 0.20 to − 0.06) | < .001 | 1.3 | 1.8 | − 0.5 (− 1.0 to 0.04) | .070 |
Use of high-dose opioid | 1.3 | 2.5 | − 1.2 (− 1.3 to − 1.1) | < .001 | 1.9 | 2.6 | − 0.7 (− 1.3 to − 0.05) | .035 |
Composite of either | 1.5 | 2.8 | − 1.3 (− 1.4 to − 1.1) | < .001 | 2.5 | 3.5 | − 1.0 (− 1.7 to − 0.2) | .010 |
Opioid prescribing for patients with neuropathic pain as the index diagnosis | ||||||||
Long-term use of opioid | 21.7 | 19.5 | 2.2 (1.3 to 3.1) | .003 | 26.9 | 36.0 | − 9.2 (− 13.6 to − 4.7) | < .001 |
Sensitivity analysis: for patients with neuropathic pain without baseline musculoskeletal or idiopathic pain | ||||||||
Long-term use of opioid | 12.1 | 10.4 | 1.8 (0.6 to 2.9) | < .001 | 25.7 | 33.1 | − 7.5 (− 12.1 to − 2.8) | < .001 |
Concurrent use of opioid and CNS depressant for opioid users | ||||||||
With any qualifying CNS depressantc | 44.1 | 33.3 | 10.8 (10.2 to 11.4) | < .001 | 58.8 | 54.1 | 4.7 (2.8 to 6.6) | < .001 |
With benzodiazepine | 19.5 | 15.3 | 4.2 (3.7 to 4.6) | < .001 | 21.0 | 23.2 | − 2.2 (− 3.8 to − 0.6) | < .001 |
With SSRI or TCA | 26.8 | 19.6 | 7.2 (6.7 to 7.7) | < .001 | 39.1 | 38.2 | 0.96 (− 0.9 to 2.8) | .307 |
With antipsychotic | 10.4 | 4.6 | 5.8 (5.4 to 6.1) | < .001 | 26.2 | 11.4 | 14.8 (13.5 to 16.1) | < .001 |
With nonbenzodiazepine | 9.5 | 8.2 | 1.3 (1.0 to 1.7) | < .001 | 6.7 | 9.7 | − 3.0 (− 4.1 to − 1.9) | < .001 |
Opioid or other scheduled analgesic regimen for moderate to severe paind | ||||||||
No use of prescription opioide | ND | ND | ND | ND | 32.7 | 24.6 | 8.1 (6.1 to 10.1) | < .001 |
No use of scheduled pain medicationf | ND | ND | ND | ND | 47.8 | 43.1 | 4.7 (2.4 to 7.0) | < .001 |
Composite of either | ND | ND | ND | ND | 60.1 | 52.5 | 7.6 (5.3 to 9.9) | < .001 |