Variation in Opioid Prescribing After Vaginal and Cesarean Birth : A Statewide Analysis
Copyright © 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved..
INTRODUCTION: Our aim was to evaluate variation in opioid prescribing rates and prescription size following childbirth across providers and hospitals.
METHODS: This retrospective cohort study analyzed claims data from a single-payer Preferred Provider Organization from June 2014 to May 2019 in 84 hospitals in a statewide quality collaborative. All patients aged 12-55 years, undergoing childbirth, with continuous enrollment in pregnancy were included. The primary outcome was the predicted rate of postpartum opioid fills from 7 days before birth to 3 days after discharge. Secondary outcomes included postpartum opioid prescription size in oral morphine equivalents, a standardized measure that includes the number of pills prescribed times the strength of the medication. Multilevel regression models accounted for clustering. We calculated attributable variation in opioid fills using the intraclass correlation coefficient.
RESULTS: Of 41,427 births, 15,459 patients (37.2%) filled a postpartum opioid prescription (vaginal, 4,624/27,536 [16.8%]; cesarean, 10,835/13,891 [78.0%]). The median postpartum prescription size was 150 oral morphine equivalents (interquartile range [IQR], 30) (vaginal, 135; [IQR, 45]; cesarean, 150 [IQR, 75]). In adjusted models, the rates of opioid prescribing after vaginal birth differed from cesarean birth (vaginal median, 12.1% [range, 1.1%-60.0%]; cesarean median, 80.4% [range, 43.6%-90.2%]). More variation in postpartum opioid fills was attributable to providers and hospitals for vaginal (provider, 29%; hospital, 24%) than cesarean birth (provider, 8%; hospital, 6%). Variation in prescription size was driven by providers for vaginal birth (provider, 27%; hospital, 6%) and providers and hospitals for cesarean birth (provider, 29%; hospital, 21%).
CONCLUSIONS: Across a statewide quality collaborative, variation in postpartum opioid prescribing is attributable to providers and hospitals. Future efforts at the provider and hospital levels are needed to implement best practices for postpartum opioid prescribing.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
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| Enthalten in: |
Women's health issues : official publication of the Jacobs Institute of Women's Health - 33(2023), 2 vom: 20. März, Seite 182-190 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Peahl, Alex F [VerfasserIn] |
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| Links: |
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| Themen: |
Analgesics, Opioid |
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| Anmerkungen: |
Date Completed 14.03.2023 Date Revised 19.04.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.whi.2022.08.007 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM346673658 |
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| 100 | 1 | |a Peahl, Alex F |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Variation in Opioid Prescribing After Vaginal and Cesarean Birth |b A Statewide Analysis |
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| 500 | |a Date Revised 19.04.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a INTRODUCTION: Our aim was to evaluate variation in opioid prescribing rates and prescription size following childbirth across providers and hospitals | ||
| 520 | |a METHODS: This retrospective cohort study analyzed claims data from a single-payer Preferred Provider Organization from June 2014 to May 2019 in 84 hospitals in a statewide quality collaborative. All patients aged 12-55 years, undergoing childbirth, with continuous enrollment in pregnancy were included. The primary outcome was the predicted rate of postpartum opioid fills from 7 days before birth to 3 days after discharge. Secondary outcomes included postpartum opioid prescription size in oral morphine equivalents, a standardized measure that includes the number of pills prescribed times the strength of the medication. Multilevel regression models accounted for clustering. We calculated attributable variation in opioid fills using the intraclass correlation coefficient | ||
| 520 | |a RESULTS: Of 41,427 births, 15,459 patients (37.2%) filled a postpartum opioid prescription (vaginal, 4,624/27,536 [16.8%]; cesarean, 10,835/13,891 [78.0%]). The median postpartum prescription size was 150 oral morphine equivalents (interquartile range [IQR], 30) (vaginal, 135; [IQR, 45]; cesarean, 150 [IQR, 75]). In adjusted models, the rates of opioid prescribing after vaginal birth differed from cesarean birth (vaginal median, 12.1% [range, 1.1%-60.0%]; cesarean median, 80.4% [range, 43.6%-90.2%]). More variation in postpartum opioid fills was attributable to providers and hospitals for vaginal (provider, 29%; hospital, 24%) than cesarean birth (provider, 8%; hospital, 6%). Variation in prescription size was driven by providers for vaginal birth (provider, 27%; hospital, 6%) and providers and hospitals for cesarean birth (provider, 29%; hospital, 21%) | ||
| 520 | |a CONCLUSIONS: Across a statewide quality collaborative, variation in postpartum opioid prescribing is attributable to providers and hospitals. Future efforts at the provider and hospital levels are needed to implement best practices for postpartum opioid prescribing | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
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| 650 | 7 | |a Morphine Derivatives |2 NLM | |
| 700 | 1 | |a Morgan, Daniel M |e verfasserin |4 aut | |
| 700 | 1 | |a Langen, Elizabeth S |e verfasserin |4 aut | |
| 700 | 1 | |a Low, Lisa Kane |e verfasserin |4 aut | |
| 700 | 1 | |a Brummett, Chad M |e verfasserin |4 aut | |
| 700 | 1 | |a Lai, Yen-Ling |e verfasserin |4 aut | |
| 700 | 1 | |a Hu, Hsou-Mei |e verfasserin |4 aut | |
| 700 | 1 | |a Bauer, Melissa |e verfasserin |4 aut | |
| 700 | 1 | |a Waljee, Jennifer |e verfasserin |4 aut | |
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