Objective: The aim of the study is to evaluate the prevalence and factors associated with opioid prescriptions to postpartum patients among TRICARE beneficiaries receiving care in the civilian health care system versus a military health care facility.
Study Design: We evaluated postpartum opioid prescriptions filled at discharge among patients insured by TRICARE Prime/Prime Plus using the Military Health System Data Repository between fiscal years 2010 to 2015. We included women aged 15 to 49 years old and excluded abortive pregnancy outcomes and incomplete datasets. The primary outcome investigated mode of delivery and demographics for those filling an opioid prescription. Secondary outcomes compared prevalence of filled opioid prescription at discharge for postpartum patients within civilian care and military care.
Results: Of a total of 508,258 postpartum beneficiaries, those in civilian health care were more likely to fill a discharge opioid prescription compared with those in military health care (OR 3.9, 95% CI 3.8-3.99). Cesarean deliveries occurred less frequently in military care (26%) compared with civilian care (30%), and forceps deliveries occurred more frequently in military care (1.38%) compared with civilian care (0.75%). Women identified as Asian race were least likely to fill an opioid prescription postpartum (OR 0.79, 95% CI 0.75-0.83). Women aged 15 to 19 years had a lower odds of filling an opioid prescription (OR 0.83, 95% CI 0.80-0.86). Women associated with a senior officer rank were less likely to fill an opioid prescription postpartum (OR 0.83, 95% CI 0.73-0.91), while those associated with warrant officer rank were more likely to fill an opioid prescription (OR 1.14, 95% CI 1.06-1.23).
Conclusion: Our data indicates that women who received care in civilian facilities were more likely to fill an opioid prescription at discharge when compared with military facilities. Factors such as race and age were associated with opioid prescription at discharge. This study highlights areas for improvement for potential further studies.
Key Points: · Opioid prescription patterns for postpartum women may vary across the country.. · Our study indicates postpartum patients in civilian care are more likely to fill opioids postpartum.. · This study highlights a population which may have an improved opioid prescribing pattern..
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http://dx.doi.org/10.1055/s-0041-1740006 | DOI Listing |
Psychol Addict Behav
January 2025
Department of Psychiatry and Behavioral Sciences, University of Washington.
Objective: Both opioid misuse and overdose mortality have disproportionately impacted the American Indian population. Although medications for opioid use disorder, such as buprenorphine (BUP-NX), are highly effective in reducing overdose mortality, questions have been raised about the cultural acceptability of Western medical approaches in this population. Understanding patients' desired recovery pathways can lead to more culturally appropriate, patient-centered, and effective approaches to opioid use disorder (OUD) treatment.
View Article and Find Full Text PDFJ Surg (Lisle)
November 2024
Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Purpose: Appropriate opioid management is crucial to reduce opioid overdose risk for ICU surgical patients, which can lead to severe complications. Accurately predicting postoperative opioid needs and understanding the associated factors can effectively guide appropriate opioid use, significantly enhancing patient safety and recovery outcomes. Although machine learning models can accurately predict postoperative opioid needs, lacking interpretability hinders their adoption in clinical practice.
View Article and Find Full Text PDFBiomedicine (Taipei)
December 2024
Division of Spine Surgery, Duke University Health, Durham, NC 27710, USA.
Introduction: Spine surgery is a common source of narcotic prescriptions and carries potential for long-term opioid dependence. As prescription opioids play a role in nearly 25 % of all opioid overdose deaths in the United States, mitigating risk for prolonged postoperative opioid utilization is crucial for spine surgeons.
Purpose: The aim of this study was to employ six ML algorithms to identify clinical variables predictive of increased opioid utilization across spinal surgeries, including anterior cervical discectomy and fusion (ACDF), posterior thoracolumbar fusion (PTLF), and lumbar laminectomy.
JAMA Netw Open
January 2025
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Importance: Academic detailing (interactive educational outreach) is a widely used strategy to encourage evidence-based prescribing by clinicians.
Objective: To evaluate academic detailing programs targeted at improving prescribing behavior and describe program aspects associated with positive outcomes.
Evidence Review: A systematic search of MEDLINE from April 1, 2007, through December 31, 2022, was performed for randomized trials and nonrandomized studies of academic detailing interventions to improve prescribing.
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