Multiple-provider opioid Rxs common in Medicare

More than three-quarters of Medicare beneficiaries with four or more providers have concurrent opioid prescriptions, suggesting fragmented care.

Multiple-provider opioid Rxs common in Medicare
Multiple-provider opioid Rxs common in Medicare

HealthDay News -- More than three-quarters of Medicare beneficiaries with four or more healthcare providers filled concurrent opioid prescriptions and those who did had higher rates of opioid-related hospital admissions, results of a retrospective cohort study indicated.

Among the 1,808,355 Medicare beneficiaries who filled at least one opioid prescription in 2010, 34.6% filled prescriptions from at least two healthcare providers, 14.2% from at least three providers and 11.9% from four or more providers, Anupam B. Jena, MD, PhD, assistant professor of health care policy and medicine at Harvard Medical School and colleagues reported in BMJ.

"[M]ultiple provider prescribing might [...] reflect fragmented care — whereby no specific physician is solely responsible for a patient's needs for opioid prescription — or intentional doctor shopping by patients," Jena and colleagues reported in BMJ.

Findings from previous studies indicate indicate between 10% and 15% of individuals prescribed an opioid obtain medications from three or more doctors in a given year. However, these studies have not looked at opioid prescribing patterns among Medicare recipients and elderly or disabled patients, who are at particular risk for adverse events.

So Jena and colleagues extracted information from a database of prescription drugs and medical claims in a 20% random sample of Medicare beneficiaries -- 75% of whom were aged 65 years and older -- to estimate the frequency and characteristics of opioid prescribing by multiple providers in 2010.

Among 1,208,100 beneficiaries with an opioid prescription, 77.2% of beneficiaries with four or more providers received concurrent opioid prescriptions from multiple providers, with the dominant provider prescribing about half of all opioids -- 7.9 out of a mean 15.2 prescriptions.

Hospital admissions related to opioid use increased with each prescribing provider, with annual unadjusted admission rates as follows:

  • One provider, 1.63% (95% CI: 1.58-1.67%)
  • Two providers, 2.08% (95% CI: 2.03%-2.14%)
  • Three providers, 2.87% (95% CI: 2.77%-2.97%) 
  • Four or more, 4.83% (95% CI: 4.70%-4.96%)

Most beneficiaries with multiple opioid providers received prescriptions from internists or family practitioners, followed by surgeons, emergency medicine physicians and physician assistants, the researchers found. 

Multiple provider opioid prescribing was highest among younger beneficiaries and black patients, as well as those who filled prescriptions for stimulants, other central nervous system drugs, non-narcotic analgesic drugs, neuromuscular drugs or antineoplastic drugs.

"Our findings reinforce the need to educate patients about the risks associated with obtaining opioid prescriptions from multiple providers," the researchers wrote.

They also suggested developing better initiatives to monitor potentially harmful drug prescribing patterns, such as creating electronic pharmacy databases that alert healthcare providers when a patient concurrently fills two or more prescriptions for an opioid from multiple providers.

References

  1. Jena AB et al. BMJ. 2014;348:g1393.
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