Opioid Prescription at Discharge Linked to Less Follow-up Care

Justin S. Liberman, MD, MPH

Patients with heart disease who were prescribed opioids at hospital discharge were less likely to participate in follow-up care than those who were not prescribed opioids, according to a study from Vanderbilt University Medical Center.

“In addition to the national focus on opioid-related overdose and mortality, it is imperative to understand how opioid use can affect a patient’s relationship with the healthcare system,” wrote the study’s authors.

Investigators found that 60.1% of participants who left with an opioid prescription did not complete a planned health care visit in the 30 days after discharge—either a follow up visit with their health care provider or a cardiac rehabilitation session. In contrast, 55.0% of those not prescribed an opioid did not complete a planned visit or session. With adjustment for covariates, the study reported that participants discharged with an opioid prescription had statistically significant decreased odds of planned health care use (adjusted odds ratio, 0.69; 95% CI, 0.52—0.91).

Planned healthcare use, however, was one of the study’s secondary outcomes. The study’s primary outcome was the time to an unplanned health care use, such as a visit to the emergency room or a hospital readmission. Patients in the opioid group were more likely to have an unplanned health care event, but this was not significant (adjusted hazard ratio, 1.06; 95% CI, 0.87—1.28).

“Hospital discharge provides a unique opportunity to evaluate each patient’s medication regimen,” said study lead author Justin S. Liberman, MD, MPH, assistant professor of anesthesiology at Vanderbilt University Medical Center in Nashville, Tennessee. “It’s important for healthcare providers to understand the other ways that opioids may affect a patient’s future interactions with the healthcare system.”

The study, nested within the Vanderbilt Inpatient Cohort Study, analyzed 2495 patients who had been admitted to the hospital for acute coronary syndrome and/or acute decompensated heart failure. Patients who were discharged with opioids (n = 501, 20.1%) were predominantly white (81%) and had a median age of 59 years. Those without an opioid prescription (n = 1994, 79.9%) were mostly white (84%), predominantly men (60.0%), with a median age of 61 years.

The opioids prescribed most often in the study were hydrocodone (n = 285, 49.6% of total prescriptions), oxycodone (n = 162, 28.2%), and tramadol (n = 75, 13.0%).

After discharge from the hospital, participants gave information about their use of medical services via telephone interviews that occurred 2-3 days, 30 days, and 90 days after discharge. Study authors noted that this was a possible limitation to the study results. Other limitations included the inability to measure the opioid prescription duration or the actual amount of opioids each patient ingested.

The study authors highlighted that the associations the investigation found do not demonstrate causality and that there are a variety of possible mechanisms to explain the associations. Possible mechanisms they suggested are that reduced planned health care use “may be caused by lethargy, physical instability, or medication nonadherence; or may be secondary to associated diseases, such as depression.”

“Our study supports reductions in opioid prescriptions to improve planned healthcare utilization behaviors,” concluded the authors, adding a call for further research in this area.

The study, “Opioid Prescriptions at Hospital Discharge Are Associated With More Postdischarge Healthcare Utilization,” was published in Journal of the American Heart Association.