Emergency Department Patients Prescribed More Opioids Than They Used

AHRQ Stats: Opioid Prescription Expenses

Opioid outpatient prescription expenses totaled $7.7 billion for adults in 2017. Nearly three-quarters of that amount was spent for hydrocodone ($3.5 billion) and oxycodone ($2.2 billion). (Source: AHRQ, Medical Expenditure Panel Survey Statistical Brief #529: Total Expenses, Total Utilization, and Sources of Payment for Outpatient Prescription Opioids in the U.S. Adult Civilian Noninstitutionalized Population, 2017.) 

Today's Headlines:

• Emergency Department Patients Prescribed More Opioids Than They Used.
• Web Conference on How Telehealth Can Increase Access to Care and Improve Healthcare Quality.
• Highlights From AHRQ’s Patient Safety Network.
• Nominations for AHRQ’s National Advisory Council Due July 3.
• New Informed Consent Resources or Telehealth.
• Definitions Vary on Omissions of Care in Nursing Facilities.
• AHRQ in the Professional Literature.

Emergency Department Patients Prescribed More Opioids Than They Used

AHRQ-funded research has found significant overprescribing of an opioid in an emergency setting. The study, published in Pain Medicine, found that nearly 93 percent of patients who were prescribed hydrocodone-acetaminophen after visiting the emergency department (ED) consumed far fewer pills than they were given. Researchers reviewed 10-day medication diaries completed by 260 patients who were prescribed the opioid at the ED, and found that while patients were prescribed an average of 12 pills, all (with the exception of those with back pain) used fewer than 12 on average. Patients with renal colic consumed the least, averaging only three pills used after 10 days. Access the abstract. 

Web Conference on How Telehealth Can Increase Access to Care and Improve Healthcare Quality

There is no charge for the Web conference, which will be held on June 9 from 2 to 3:30 p.m. ET. Presenters will discuss their work on the effectiveness of telepsychiatry, the impact of telemedicine on chronic disease management and the factors that help or hinder the use of telemedicine in urban areas. The Web conference also will cover the evidence about how telehealth can be used routinely and during public health emergencies such as a pandemic.

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

• Pain management best practices from multispecialty organizations during the COVID-19 pandemic and public health crises.
• Prevalence of harmful diagnostic errors in hospitalised adults: a systematic review and meta-analysis.
• Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19).

PSNet has also posted a new issue of WebM&M (Morbidity and Mortality Rounds on the Web), which features expert analysis on medical errors. The three new cases in this issue explore Implicit Biases, Interprofessional Communication, and Power Dynamics; Delayed Management of Necrotizing Soft Tissue Infection; and Complications of ECMO During Transport.

Nominations for AHRQ’s National Advisory Council Due July 3

AHRQ is soliciting nominations for seven new members of its National Advisory Council, which advises HHS Secretary Alex M. Azar and AHRQ Director Gopal Khanna, M.B.A., on research activities and priorities. To fill these positions, the agency seeks individuals who can contribute varied perspectives on the healthcare system and on AHRQ’s research focus to promote improvements in quality, outcomes and cost-effectiveness of clinical practice. Nominations are due by July 3. The seven new members will begin their three-year terms in spring 2021. Access the Federal Register notice for more information.

New Informed Consent Resources for Telehealth

As the COVID-19 pandemic has forced healthcare providers to limit in-person visits, telehealth has expanded rapidly. In response to the need to obtain informed consent from patients for virtual visits, AHRQ has created a sample telehealth consent form (Word, 26.6 KB) that is easy to understand and guidance for clinicians on how to obtain informed consent for telehealth. Access more information about AHRQ’s telehealth consent form and other health literacy resources.

Definitions Vary on Omissions of Care in Nursing Facilities

The healthcare community’s current definitions of omissions of care in nursing facilities vary widely, according to an AHRQ-funded literature review in the Journal of the American Medical Directors Association. Authors reviewed 34 published articles on omissions of care, plus 327 more on adverse events attributable to omissions. They found broad agreement that any delay or adverse event constituted an omission. Definitions often differed, however, in what risks or adverse events were included, how different components of care delivery were considered, whether they recognized both clinical and psychosocial care, and how insufficient resources can play a role in creating omissions. Access the abstract.

AHRQ in the Professional Literature

How do changes in income, employment and health insurance affect family mental health spending? Grafova IB, Monheit AC, Kumar R. Rev Econ Househ 2020 Mar;18(1):239-63. Epub 2018 Nov 7. Access the abstract on PubMed®.

A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers. Nembhard IM, Buta E, Lee YSH, et al. BMC Health Serv Res 2020 Feb 24;20(1):137. Access the abstract on PubMed®.

Role of post-acute care in readmissions for preexisting healthcare-associated infections. Hoffman GJ, Min LC, Liu H, et al. J Am Geriatr Soc 2020 Feb;68(2):370-8. Epub 2019 Oct 23. Access the abstract on PubMed®.

Association of neutrophil-to-lymphocyte ratio with outcomes after elective abdominal aortic aneurysm repair. Bath J, Smith JB, Kruse RL, et al. J Vasc Nurs 2019 Sep;37(3):213-20. Epub 2019 Sep 12. Access the abstract on PubMed®.

Neutrophil-lymphocyte ratio predicts disease severity and outcome after lower extremity procedures. Bath J, Smith JB, Kruse RL, et al. J Vasc Surg 2019 Dec 24. [Epub ahead of print.] Access the abstract on PubMed®.

Re-examining "Never Letting the Sun Rise or Set on a Bowel Obstruction" in the era of acute care surgery. Diaz A, Ricci KB, Rushing AP, et al. J Gastrointest Surg 2020 Feb 10. [Epub ahead of print.] Access the abstract on PubMed®.

The Affordable Care Act Medicaid expansion positively impacted community health centers and their patients. Tilhou AS, Huguet N, Devoe J, et al. J Gen Intern Med 2020 Apr;35(4):1292-5. Epub 2020 Jan 2. Access the abstract on PubMed®.

Patient activation related to fall prevention: a multisite study. Christiansen TL, Lipsitz S, Scanlan M, et al. Jt Comm J Qual Patient Saf 2020 Mar;46(3):129-35. Epub 2020 Jan 13. Access the abstract on PubMed®.