Background: Pharmacoepidemiologic studies utilize the days’ supply field in prescription (Rx) claims to classify exposures and outcomes; however, data on the accuracy of days’ supply are lacking. In the United States, days’ supply is calculated at the time of Rx filling. Pharmacists’ interpretation may influence days’ supply calculations leading to variability.
Objectives: The objectives of this study are to assess consistency of pharmacists’ calculation of days’ supply for opioid Rxs and identify factors pharmacists consider when calculating days’ supply for a given Rx.
Methods: A cross-sectional survey was designed to collect information from Kentucky-licensed pharmacists about opioid analgesic dispensing practices and days’ supply calculations. The survey was distributed electronically via email through the Kentucky Board of Pharmacy. Responses were collected anonymously over a 4-week period in December 2019. Inclusion criterion was experience dispensing opioid analgesics; other questions were voluntary. For days’ supply calculations, pharmacists saw 2 hypothetical opioid Rxs and calculated days’ supply. Additional questions examined factors influencing days’ supply and pharmacists’ perception of the importance of accuracy.
Results: Of 753 responses, 643 were eligible. For hydrocodone tablets, 19.4% (n=347) of pharmacists assigned inaccurate days’ supply, ranging from 7 days to 90 days. Common mistakes were 40 and 45 days instead of the correct 30. For morphine solution, days’ supply was inaccurate in 10.0% (n=351), ranging from 2 to 90 days. Common mistakes were 10 and 15 days instead of the correct 7. Most reported considerations when assigning days’ supply were instructions from the prescriber on intended duration (75.5%), third-party payer restrictions (48.4%) and familiarity with practitioners prescribing habits (45.3%). Most pharmacists perceived that accurate days’ supply are important to determine when medication is due to be filled/refilled (89.8%) and to support safe medication use for patients (80.8%), although fewer perceive accuracy as important for calculating morphine milligram equivalents (61.8%) and assessment of doctor shopping in the state prescription drug monitoring program (63.7%).
Conclusions: Between 10-20% of pharmacists inaccurately assigned days’ supply values to opioid analgesic Rx. While most believe accuracy in days’ supply is important to dispensing decisions, fewer consider it important for other activities such as surveillance monitoring. The estimated error rate from the survey will be used to inform the design of a validation study using stratification-sampled pharmacy records.
The proportion of patients in the United States receiving postsurgical opioids exceeding recommended thresholds increased between 2006 and 2015
Creator:
Jonsson-Funk, Michele, Stürmer, Til, Young, Jessica, and Chidgey, Brooke
Date of publication:
August 27, 2019
Abstract Tesim:
Background: Studies have found that patients routinely receive more opioids than medically necessary for adequate postsurgical pain management. This excess prescribing contributes to unused supply, increasing the risk of diversion and nonmedical use. In response to the US opioid crisis, opioid prescription (Rx) limits have been implemented on a state-by-state basis beginning in 2016, with 32 states currently enforcing prescribing limits.
Objectives: Among a broad cohort of opioid-naïve surgical patients in the US, examine trends in 1) the proportion filling opioid Rxs for postsurgical pain, and 2) the initial volume prescribed.
Methods: We identified patients undergoing surgery in MarketScan (2006–2015) and Medicare (2007–2015) claims. We defined the index opioid Rx for postsurgical pain as the first opioid filled in the week surrounding surgery following 180 days with no prior use. To reflect recent policy recommendations, we examined the proportion of patients whose index opioid Rx exceeded 7 days supply, 40 quantity dispensed (QTY), or 300 morphine milligram equivalents (MME).
Results: We identified 5,148,485 opioid-naïve surgical patients in MarketScan (mean age = 45), of whom 2,957,115 (55%) received an index opioid (median: days supply = 5; QTY = 30; MME = 240). The proportion of all patients with an index opioid Rx increased from 51% in 2006 to 62% in 2013, followed by a decline to 42% in 2015. Among patients receiving an index opioid, the proportion receiving >7 days supply increased monotonically, nearly doubling between 2006 (11%) and 2015 (19%). Similarly, the proportion of patients receiving >40 QTY more than doubled throughout the study period, rising from 14% in 2006 to 29% in 2015, and the proportion receiving >300 MME rose from 21% in 2006 to 34% in 2015. Parallel analyses in Medicare found that the proportion receiving post-op opioids continued to increase through 2015, with parallel trends of increasing proportions of patients filling index opioid Rxs above defined thresholds throughout the study period.
Conclusions: Between 2005 and 2013, there was an increase in both the probability of opioid receipt for postsurgical pain, and the proportion of Rxs exceeding recommended thresholds. While the proportion of patients filling opioids began to decline in 2014 among the MarketScan population, the proportion of high threshold Rxs continued to increase. Understanding trends in post-surgical prescribing are vital in informing and evaluating policies aimed at reducing unnecessary opioid exposure and curbing the opioid crisis in the US.
Affiliation Label Tesim:
Gillings School of Global Public Health, Cecil G. Sheps Center for Health Services Research, and School of Medicine
Type:
http://purl.org/dc/dcmitype/Text
DOI:
https://doi.org/10.17615/pbqn-c988
Language Label:
English
ORCID:
Other Affiliation:
Person:
Jonsson-Funk, Michele, Stürmer, Til, Young, Jessica, and Chidgey, Brooke
