Which physician treats a patient in the emergency room may determine how long the patient stays on opioids, according to a study published Wednesday in TheNew England Journal of Medicine.
For the study, researchers examined 377,629 Medicare beneficiaries who visited the ER from 2008 through 2011 and had not received prescriptions for opioids within six months before their visit. Researchers said they identified emergency physicians within a hospital who cared for the patients, then categorized the physicians as high-intensity or low-intensity opioid prescribers according to relative quartiles of prescribing rates within the same hospital. Additionally, researchers compared rates of long-term opioid use, defined as six months of days supplied, in the 12 months after an ER visit among patients treated by high-intensity or low-intensity prescribers, with adjustment for patient characteristics.
The study found some emergency physicians within the same hospital are three times more likely to prescribe an opioid than other physicians. Researchers also found increased rates of long-term opioid use among patients treated by high-intensity opioid prescribers.
Patients treated by a high-intensity prescriber were approximately 30 percent more likely to end up with a long-term opioid prescription of at least six months within the year following their hospital visit, reports Kaiser Health News. Overall, the report states, about 2 percent Medicare patients prescribed an opioid in the study were likely to become a long-term opioid user.
"We found variation by a factor of more than three in rates of opioid prescribing by emergency physicians within the same hospital and increased rates of long-term opioid use among patients treated by high-intensity opioid prescribers," the study's authors concluded. "These results suggest that an increased likelihood of receiving an opioid for even one encounter could drive clinically significant future long-term opioid use and potentially increased adverse outcomes among the elderly. Future research may explore whether this variation reflects overprescription by some prescribers and whether it is amenable to intervention."