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Quality of opioid prescribing in older adults with or without Alzheimer disease and related dementia.
Wei, Yu-Jung Jenny; Schmidt, Siegfried; Chen, Cheng; Fillingim, Roger B; Reid, M Carrington; DeKosky, Steven; Solberg, Laurence; Pahor, Marco; Brumback, Babette; Winterstein, Almut G.
Afiliação
  • Wei YJ; Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Drive, Health Professions Nursing Pharmacy Building, Room 3321, Gainesville, FL, 32610, USA. jenny.wei@cop.ufl.edu.
  • Schmidt S; Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA. jenny.wei@cop.ufl.edu.
  • Chen C; Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
  • Fillingim RB; Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Drive, Health Professions Nursing Pharmacy Building, Room 3321, Gainesville, FL, 32610, USA.
  • Reid MC; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, USA.
  • DeKosky S; College of Dentistry, University of Florida, Gainesville, FL, USA.
  • Solberg L; Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA.
  • Pahor M; Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.
  • Brumback B; NF/SG Veterans Health System, Malcom Randall VAMC, Geriatrics Research, Education, Clinical Center (GRECC), Gainesville, FL, USA.
  • Winterstein AG; University of Florida College of Nursing, Gainesville, FL, USA.
Alzheimers Res Ther ; 13(1): 78, 2021 04 12.
Article em En | MEDLINE | ID: mdl-33883028
BACKGROUND: Pain is common among individuals with Alzheimer's disease and related dementias (ADRD), and use of opioids has been increasing over the last decade. Yet, it is unclear to what extent opioids are appropriately prescribed for patients with ADRD and whether the appropriateness of opioid prescribing differs by ADRD status. The objective of this study is to compare the quality of opioid prescribing among patients with or without ADRD who have chronic noncancer pain. METHODS: A nationally representative cohort study of Medicare beneficiaries aged 50 years or older who had chronic pain but who had no cancer, hospice, or palliative care from 2011 to 2015. Four indicators of potentially inappropriate opioid prescribing were measured in patients residing in communities (75,258 patients with and 435,870 patients without ADRD); five indicators were assessed in patients in nursing homes (NHs) (37,117 patients with and 5128 patients without ADRD). Each indicator was calculated as the proportion of eligible patients with inappropriate opioid prescribing in the year after a chronic pain diagnosis. Differences in proportions between ADRD and non-ADRD groups were estimated using a generalized linear model adjusting for covariates through inverse probability weighting. RESULTS: Patients with ADRD versus those without had higher concurrent use of opioids and central nervous system-active drugs (community 44.1% vs 33.3%; NH 58.8% vs 54.1%, both P < 0.001) and no opioids or scheduled pain medications for moderate or severe pain (NH 60.1% vs 52.5%, P < 0.001). The ADRD versus non-ADRD group had higher use of long-term opioids for treating neuropathic pain in communities (21.7% vs 19.5%, P = 0.003) but lower use in NHs (26.9% vs 36.0%, P < 0.001). Use of strong or high-dose opioids when naive to opioids (community 1.5% vs 2.8%; NH 2.5% vs 3.5%) and use of contraindicated opioids (community 0.08% vs 0.12%; NH 0.05% vs 0.21%) were rare for either group. CONCLUSION: Potential inappropriate opioid prescribing in 2 areas of pain care was more common among patients with ADRD than among patients without ADRD in community or NH settings. Further studies aimed at understanding the factors and effects associated with opioid prescribing patterns that deviate from guidelines are warranted.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Doença de Alzheimer / Dor Crônica Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans País/Região como assunto: America do norte Idioma: En Revista: Alzheimers Res Ther Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Doença de Alzheimer / Dor Crônica Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans País/Região como assunto: America do norte Idioma: En Revista: Alzheimers Res Ther Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos