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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
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.
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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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