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Balancing Safety, Comfort, and Fall Risk: An Intervention to Limit Opioid and Benzodiazepine Prescriptions for Geriatric Patients
INTRODUCTION: This study reports on the impact of a clinical decision support tool embedded in the electronic medical record and characterizes the demographics, prescribing patterns, and risk factors associated with opioid and benzodiazepine misuse in the older adult population. SIGNIFICANCE: This s...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9561667/ https://www.ncbi.nlm.nih.gov/pubmed/36250188 http://dx.doi.org/10.1177/21514593221125616 |
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author | Bloomer, Ainsley Wally, Meghan Bailey, Gisele Roomian, Tamar Karunakar, Madhav Hsu, Joseph R Seymour, Rachel Beuhler, Michael Bosse, Michael Gibbs, Michael Griggs, Christopher Jarrett, Steven Leas, Daniel Odum, Susan Runyon, Michael Saha, Animita Yu, Ziquing Watling, Brad Wyatt, Stephen |
author_facet | Bloomer, Ainsley Wally, Meghan Bailey, Gisele Roomian, Tamar Karunakar, Madhav Hsu, Joseph R Seymour, Rachel Beuhler, Michael Bosse, Michael Gibbs, Michael Griggs, Christopher Jarrett, Steven Leas, Daniel Odum, Susan Runyon, Michael Saha, Animita Yu, Ziquing Watling, Brad Wyatt, Stephen |
author_sort | Bloomer, Ainsley |
collection | PubMed |
description | INTRODUCTION: This study reports on the impact of a clinical decision support tool embedded in the electronic medical record and characterizes the demographics, prescribing patterns, and risk factors associated with opioid and benzodiazepine misuse in the older adult population. SIGNIFICANCE: This study reports on prescribing patterns for patients ≥65 years-old who presented to Emergency Departments (ED) or Urgent Care (UC) facilities across a large healthcare system following a fall (n = 34,334 encounters; n = 25,469 patients). This system implemented a clinical decision support intervention which provides an alert when the patient has an evidence-based risk factor for prescription drug misuse; prescribers can continue, amend or cancel the prescription. RESULTS: Of older adults presenting with a fall, 31.4% (N = 7986) received an opioid or benzodiazepine prescription. Women and younger patients (65-74) had a higher likelihood of receiving a prescription (P < .0001). 11% had ≥1 risk factor. Women were more likely to receive an early refill (P = .0002) and younger (65-74) men were more likely to have a past positive toxicology (P < .0001). A prescription was initiated in 8,591 encounters, and 946 (9.0%) triggered an alert. In 58 cases, the alert resulted in a prescription modification, and in 80 the prescription was canceled. CONCLUSIONS: Documented risk for opioid misuse in the elderly was 10% among patients presenting to the ED/UC after a fall. The dangers associated with opioid/benzodiazepine use increase with age as does fall risk. Awareness of risk factors is an important first step; more work is needed to address potentially hazardous prescriptions in this population. |
format | Online Article Text |
id | pubmed-9561667 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-95616672022-10-15 Balancing Safety, Comfort, and Fall Risk: An Intervention to Limit Opioid and Benzodiazepine Prescriptions for Geriatric Patients Bloomer, Ainsley Wally, Meghan Bailey, Gisele Roomian, Tamar Karunakar, Madhav Hsu, Joseph R Seymour, Rachel Beuhler, Michael Bosse, Michael Gibbs, Michael Griggs, Christopher Jarrett, Steven Leas, Daniel Odum, Susan Runyon, Michael Saha, Animita Yu, Ziquing Watling, Brad Wyatt, Stephen Geriatr Orthop Surg Rehabil Original Manuscript INTRODUCTION: This study reports on the impact of a clinical decision support tool embedded in the electronic medical record and characterizes the demographics, prescribing patterns, and risk factors associated with opioid and benzodiazepine misuse in the older adult population. SIGNIFICANCE: This study reports on prescribing patterns for patients ≥65 years-old who presented to Emergency Departments (ED) or Urgent Care (UC) facilities across a large healthcare system following a fall (n = 34,334 encounters; n = 25,469 patients). This system implemented a clinical decision support intervention which provides an alert when the patient has an evidence-based risk factor for prescription drug misuse; prescribers can continue, amend or cancel the prescription. RESULTS: Of older adults presenting with a fall, 31.4% (N = 7986) received an opioid or benzodiazepine prescription. Women and younger patients (65-74) had a higher likelihood of receiving a prescription (P < .0001). 11% had ≥1 risk factor. Women were more likely to receive an early refill (P = .0002) and younger (65-74) men were more likely to have a past positive toxicology (P < .0001). A prescription was initiated in 8,591 encounters, and 946 (9.0%) triggered an alert. In 58 cases, the alert resulted in a prescription modification, and in 80 the prescription was canceled. CONCLUSIONS: Documented risk for opioid misuse in the elderly was 10% among patients presenting to the ED/UC after a fall. The dangers associated with opioid/benzodiazepine use increase with age as does fall risk. Awareness of risk factors is an important first step; more work is needed to address potentially hazardous prescriptions in this population. SAGE Publications 2022-10-12 /pmc/articles/PMC9561667/ /pubmed/36250188 http://dx.doi.org/10.1177/21514593221125616 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Manuscript Bloomer, Ainsley Wally, Meghan Bailey, Gisele Roomian, Tamar Karunakar, Madhav Hsu, Joseph R Seymour, Rachel Beuhler, Michael Bosse, Michael Gibbs, Michael Griggs, Christopher Jarrett, Steven Leas, Daniel Odum, Susan Runyon, Michael Saha, Animita Yu, Ziquing Watling, Brad Wyatt, Stephen Balancing Safety, Comfort, and Fall Risk: An Intervention to Limit Opioid and Benzodiazepine Prescriptions for Geriatric Patients |
title | Balancing Safety, Comfort, and Fall Risk: An Intervention to Limit
Opioid and Benzodiazepine Prescriptions for Geriatric Patients |
title_full | Balancing Safety, Comfort, and Fall Risk: An Intervention to Limit
Opioid and Benzodiazepine Prescriptions for Geriatric Patients |
title_fullStr | Balancing Safety, Comfort, and Fall Risk: An Intervention to Limit
Opioid and Benzodiazepine Prescriptions for Geriatric Patients |
title_full_unstemmed | Balancing Safety, Comfort, and Fall Risk: An Intervention to Limit
Opioid and Benzodiazepine Prescriptions for Geriatric Patients |
title_short | Balancing Safety, Comfort, and Fall Risk: An Intervention to Limit
Opioid and Benzodiazepine Prescriptions for Geriatric Patients |
title_sort | balancing safety, comfort, and fall risk: an intervention to limit
opioid and benzodiazepine prescriptions for geriatric patients |
topic | Original Manuscript |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9561667/ https://www.ncbi.nlm.nih.gov/pubmed/36250188 http://dx.doi.org/10.1177/21514593221125616 |
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