Association of Primary Care Risk Mitigation Visits and Nonelective Emergency Department Visits in Patients Using Long-term Opioid Therapy

Nancy V. Koch MD , Richard J. Butterfield III MA
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Abstract

Objective

To determine risk factors for nonelective emergency department visits (NEDVs) and whether primary care visits incorporating risk mitigation tools prevented NEDVs among patients using long-term opioid therapy (LOT).

Patients and Methods

We retrospectively searched the electronic health records at Mayo Clinic primary care outpatient practices in Arizona and Florida in all of 2018 and 2019 for the records of individual adult patients using LOT. Patient and clinician demographic characteristics and patient risk factors were compared between patients with and without risk mitigation visits. Univariate and multivariable logistic regression was used to determine risk factors for NEDVs.

Results

Among 457 patients using LOT identified during the study period, most were women (n=266, 58.2%), and the median age was 69 years. Long-term opioid therapy risk mitigation visits were performed equally by family medicine and internal medicine clinicians and by a significantly higher proportion of Florida clinicians than Arizona clinicians (87.0% vs 70.5%; P<.001). Older age, falls, and mental health care utilization all increased the risk of NEDVs. Risk mitigation visits were protective against NEDVs (odds ratio, 0.56; 95% CI, 0.35-0.89; P=.01) after adjustment for older age, falls, and mental health care utilization.

Conclusion

Risk mitigation visits are effective in preventing NEDVs, and all patients using LOT should have such visits when possible.

长期阿片类药物治疗患者的初级保健风险缓解就诊和非选择性急诊就诊的相关性
目的确定非选择性急诊就诊(NEDVs)的风险因素,以及纳入风险缓解工具的初级保健就诊是否能在使用长期阿片类药物治疗(LOT)的患者中预防NEDVs。患者和方法我们回顾性检索了2018年和2019年亚利桑那州和佛罗里达州梅奥诊所初级保健门诊的电子健康记录用于使用LOT的个体成年患者的记录。比较了有和没有风险缓解访视的患者和临床医生的人口统计学特征以及患者风险因素。使用单变量和多变量逻辑回归来确定NEDVs的风险因素。结果在研究期间确定的457名使用LOT的患者中,大多数是女性(n=266,58.2%),中位年龄为69岁。家庭医学和内科临床医生平均进行了长期阿片类药物治疗风险缓解访视,佛罗里达州临床医生的比例明显高于亚利桑那州临床医生(87.0%对70.5%;P<;.001)。年龄较大、跌倒和心理健康护理使用均增加了NEDVs的风险。在对年龄、跌倒和心理健康护理利用率进行调整后,风险缓解访视对NEDVs具有保护作用(比值比,0.56;95%可信区间,0.35-0.89;P=0.01)。结论风险缓解访视可有效预防NEDVs,所有使用LOT的患者应尽可能进行此类访视。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Mayo Clinic proceedings. Innovations, quality & outcomes
Mayo Clinic proceedings. Innovations, quality & outcomes Surgery, Critical Care and Intensive Care Medicine, Public Health and Health Policy
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