Impact of Geriatrics Comanagement on Pain Medication Prescribing for Older Adults Across 3 Surgical Specialties: A Pre-Post Study.

Abstract

Background: Older injured patients are at risk for inappropriate pain management, including undertreatment of their pain and inappropriate medication use. The primary aim of this study was to examine the impact of geriatric comanagement on pain medication prescribing in hospitalized older adults.

Setting: Single-site urban academic hospital.

Participants: Patients aged 65 years and older admitted to orthopedic trauma, general trauma, and neurosurgery services.

Methods: Pre-post intervention study from 2017 to 2020, using propensity score matching. We compared pain medication prescribing before and after implementation of a geriatric comanagement program. We tracked whether pain medications were received during hospitalization, and the total number of administrations per patient for each class of pain medications.

Results: A total of 2640 patients were included, and analytic sample sizes varied by outcome and subsample studied. Comanaged patients in the postintervention group were more likely to receive pain medications than the preintervention group (14.2%, 95% CI: 4.0-24.4, P=0.006), including opioids (20.1%, 95% CI: 2.5-37.6, P=0.025) and nonopioids (15.6%, 95% CI: 4.0-27.3, P=0.009). Comanaged patients had an increase in the administration of nonopioids (62.1%, P<0.001) without a significant increase in the administration of opioids.

Conclusion: The introduction of geriatric comanagement was associated with changes in pain medication prescribing practices. While our study did not include pain outcome measures, the observed changes in pain medication prescribing add to the growing evidence supporting the benefits of geriatric comanagement models of care because appropriate prescribing facilitates pain management.