Tags

Type your tag names separated by a space and hit enter

Trends in Opioid Analgesic Use in Encounters Involving Physician Trainees in U.S. Emergency Departments.
Pain Med. 2016 12; 17(12):2389-2396.PM

Abstract

BACKGROUND

Opioid analgesic use has increased dramatically in emergency departments (EDs), but the relative contribution of physician trainees has not been explored. We assessed trends in opioid utilization focusing on ED encounters where a physician trainee was involved.

METHODS

We studied ED visits from the National Hospital Ambulatory Medical Care Survey, 2001-2011. Adult ED visits in which an opioid was administered in the ED or prescribed at discharge were stratified by whether or not there was trainee involvement. Trends in use over time for five common opioids (codeine, hydrocodone, hydromorphone, morphine, oxycodone) were tested using survey-weighted logistic regression.

RESULTS

From 2001-02 to 2009-11, the proportion of ED visits where an opioid analgesic was used increased 31.5% from 21.9% (95% CI: 20.3-23.6) of visits to 28.8% (95% CI: 27.5-30.1). Trainee involvement in ED visits was stable, with 9.3% (95% CI: 7.7-11.3) seen by a trainee in 2001-02 vs. 10.2% (95% CI: 8.1-12.7) in 2010-11. Opioid use in visits with trainee involvement did not change significantly over time relative to visits without a trainee (increase of 36.8% compared to 31.2% without trainees, P = 0.652). Trends in opioid utilization for trainee visits paralleled non-trainee visits. Hydromorphone had the greatest relative increase in use for all providers. Adjusted for patient- and hospital-level factors, the probability of receiving opioids when a trainee was involved increased to a greater extent than among non-trainee visits (30.9% vs. 24.0%).

CONCLUSION

Opioid utilization patterns for visits involving trainees reflect similar trends in attending practice, and highlights the more liberal opioid prescribing climate over time.

Authors+Show Affiliations

*Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC. Georgetown University School of Medicine, Washington, DC.Center for Clinical Practice Innovation, The George Washington University, Washington, DC.*Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC. Georgetown University School of Medicine, Washington, DC.Center for Clinical Practice Innovation, The George Washington University, Washington, DC. Department of Emergency Medicine, The George Washington University, Washington, DC.Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York. *Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC.Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28025373

Citation

Mazer-Amirshahi, Maryann, et al. "Trends in Opioid Analgesic Use in Encounters Involving Physician Trainees in U.S. Emergency Departments." Pain Medicine (Malden, Mass.), vol. 17, no. 12, 2016, pp. 2389-2396.
Mazer-Amirshahi M, Mullins PM, Sun C, et al. Trends in Opioid Analgesic Use in Encounters Involving Physician Trainees in U.S. Emergency Departments. Pain Med. 2016;17(12):2389-2396.
Mazer-Amirshahi, M., Mullins, P. M., Sun, C., Pines, J. M., Nelson, L. S., & Perrone, J. (2016). Trends in Opioid Analgesic Use in Encounters Involving Physician Trainees in U.S. Emergency Departments. Pain Medicine (Malden, Mass.), 17(12), 2389-2396. https://doi.org/10.1093/pm/pnw048
Mazer-Amirshahi M, et al. Trends in Opioid Analgesic Use in Encounters Involving Physician Trainees in U.S. Emergency Departments. Pain Med. 2016;17(12):2389-2396. PubMed PMID: 28025373.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in Opioid Analgesic Use in Encounters Involving Physician Trainees in U.S. Emergency Departments. AU - Mazer-Amirshahi,Maryann, AU - Mullins,Peter M, AU - Sun,Christie, AU - Pines,Jesse M, AU - Nelson,Lewis S, AU - Perrone,Jeanmarie, Y1 - 2016/04/14/ PY - 2016/12/28/entrez PY - 2016/12/28/pubmed PY - 2017/10/4/medline KW - Emergency Department KW - Opioids KW - Trainee SP - 2389 EP - 2396 JF - Pain medicine (Malden, Mass.) JO - Pain Med VL - 17 IS - 12 N2 - BACKGROUND: Opioid analgesic use has increased dramatically in emergency departments (EDs), but the relative contribution of physician trainees has not been explored. We assessed trends in opioid utilization focusing on ED encounters where a physician trainee was involved. METHODS: We studied ED visits from the National Hospital Ambulatory Medical Care Survey, 2001-2011. Adult ED visits in which an opioid was administered in the ED or prescribed at discharge were stratified by whether or not there was trainee involvement. Trends in use over time for five common opioids (codeine, hydrocodone, hydromorphone, morphine, oxycodone) were tested using survey-weighted logistic regression. RESULTS: From 2001-02 to 2009-11, the proportion of ED visits where an opioid analgesic was used increased 31.5% from 21.9% (95% CI: 20.3-23.6) of visits to 28.8% (95% CI: 27.5-30.1). Trainee involvement in ED visits was stable, with 9.3% (95% CI: 7.7-11.3) seen by a trainee in 2001-02 vs. 10.2% (95% CI: 8.1-12.7) in 2010-11. Opioid use in visits with trainee involvement did not change significantly over time relative to visits without a trainee (increase of 36.8% compared to 31.2% without trainees, P = 0.652). Trends in opioid utilization for trainee visits paralleled non-trainee visits. Hydromorphone had the greatest relative increase in use for all providers. Adjusted for patient- and hospital-level factors, the probability of receiving opioids when a trainee was involved increased to a greater extent than among non-trainee visits (30.9% vs. 24.0%). CONCLUSION: Opioid utilization patterns for visits involving trainees reflect similar trends in attending practice, and highlights the more liberal opioid prescribing climate over time. SN - 1526-4637 UR - https://www.unboundmedicine.com/medline/citation/28025373/Trends_in_Opioid_Analgesic_Use_in_Encounters_Involving_Physician_Trainees_in_U_S__Emergency_Departments_ L2 - https://academic.oup.com/painmedicine/article-lookup/doi/10.1093/pm/pnw048 DB - PRIME DP - Unbound Medicine ER -