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The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015.
West J Emerg Med. 2016 Jul; 17(4):396-403.WJ

Abstract

INTRODUCTION

The purpose of the study was to measure national prescribing patterns for hydrocodone/acetaminophen among veterans seeking emergency medical care, and to see if patterns have changed since this medication became a Schedule II controlled substance.

METHODS

We conducted a retrospective cohort study of emergency department (ED) visits within the Veterans Health Administration (VA) between January 2009 and June 2015. We looked at demographics, comorbidities, utilization measures, diagnoses, and prescriptions.

RESULTS

During the study period, 1,709,545 individuals participated in 6,270,742 ED visits and received 471,221 prescriptions for hydrocodone/acetaminophen (7.5% of all visits). The most common diagnosis associated with a prescription was back pain. Prescriptions peaked at 80,776 in 2011 (8.7% of visits), and declined to 35,031 (5.6%) during the first half of 2015 (r=-0.99, p<0.001). The percentage of hydrocodone/acetaminophen prescriptions limited to 12 pills increased from 22% (13,949) in 2009 to 31% (11,026) in the first half of 2015. A prescription was more likely written for patients with a pain score≥7 (OR 3.199, CI [3.192-3.205]), a musculoskeletal (OR 1.622, CI [1.615-1.630]) or soft tissue (OR 1.656, CI [1.649-1.664]) diagnosis, and those below the first quartile for total ED visits (OR 1.282, CI [1.271-1.293]) and total outpatient ICD 9 codes (OR 1.843, CI [1.833-1.853]).

CONCLUSION

Hydrocodone/acetaminophen is the most frequently prescribed ED medication in the VA. The rate of prescribing has decreased since 2011, with the rate of decline remaining unchanged after it was classified as a Schedule II controlled substance. The proportion of prescriptions falling within designated guidelines has increased but is not at goal.

Authors+Show Affiliations

University of Maryland, Department of Emergency Medicine, Baltimore, Maryland.University of Maryland, Department of Emergency Medicine, Baltimore, Maryland.University of Maryland, National Study Center for Trauma and EMS, Maryland.University of Maryland, Department of Emergency Medicine, Baltimore, Maryland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27482304

Citation

Grasso, Michael A., et al. "The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015." The Western Journal of Emergency Medicine, vol. 17, no. 4, 2016, pp. 396-403.
Grasso MA, Dezman ZD, Comer AC, et al. The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015. West J Emerg Med. 2016;17(4):396-403.
Grasso, M. A., Dezman, Z. D., Comer, A. C., & Jerrard, D. A. (2016). The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015. The Western Journal of Emergency Medicine, 17(4), 396-403. https://doi.org/10.5811/westjem.2016.5.29924
Grasso MA, et al. The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015. West J Emerg Med. 2016;17(4):396-403. PubMed PMID: 27482304.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015. AU - Grasso,Michael A, AU - Dezman,Zachary D W, AU - Comer,Angela C, AU - Jerrard,David A, Y1 - 2016/06/15/ PY - 2016/01/31/received PY - 2016/04/14/revised PY - 2016/05/05/accepted PY - 2016/8/3/entrez PY - 2016/8/3/pubmed PY - 2017/8/8/medline SP - 396 EP - 403 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 17 IS - 4 N2 - INTRODUCTION: The purpose of the study was to measure national prescribing patterns for hydrocodone/acetaminophen among veterans seeking emergency medical care, and to see if patterns have changed since this medication became a Schedule II controlled substance. METHODS: We conducted a retrospective cohort study of emergency department (ED) visits within the Veterans Health Administration (VA) between January 2009 and June 2015. We looked at demographics, comorbidities, utilization measures, diagnoses, and prescriptions. RESULTS: During the study period, 1,709,545 individuals participated in 6,270,742 ED visits and received 471,221 prescriptions for hydrocodone/acetaminophen (7.5% of all visits). The most common diagnosis associated with a prescription was back pain. Prescriptions peaked at 80,776 in 2011 (8.7% of visits), and declined to 35,031 (5.6%) during the first half of 2015 (r=-0.99, p<0.001). The percentage of hydrocodone/acetaminophen prescriptions limited to 12 pills increased from 22% (13,949) in 2009 to 31% (11,026) in the first half of 2015. A prescription was more likely written for patients with a pain score≥7 (OR 3.199, CI [3.192-3.205]), a musculoskeletal (OR 1.622, CI [1.615-1.630]) or soft tissue (OR 1.656, CI [1.649-1.664]) diagnosis, and those below the first quartile for total ED visits (OR 1.282, CI [1.271-1.293]) and total outpatient ICD 9 codes (OR 1.843, CI [1.833-1.853]). CONCLUSION: Hydrocodone/acetaminophen is the most frequently prescribed ED medication in the VA. The rate of prescribing has decreased since 2011, with the rate of decline remaining unchanged after it was classified as a Schedule II controlled substance. The proportion of prescriptions falling within designated guidelines has increased but is not at goal. SN - 1936-9018 UR - https://www.unboundmedicine.com/medline/citation/27482304/The_Decline_in_Hydrocodone/Acetaminophen_Prescriptions_in_Emergency_Departments_in_the_Veterans_Health_Administration_Between_2009_to_2015_ L2 - http://escholarship.org/uc/item/29d2w30f DB - PRIME DP - Unbound Medicine ER -