Cited 12 time in webofscience Cited 12 time in scopus

Association of Care Practices with Suicide Attempts in US Veterans Prescribed Opioid Medications for Chronic Pain Management

Title
Association of Care Practices with Suicide Attempts in US Veterans Prescribed Opioid Medications for Chronic Pain Management
Authors
Im, Jinwoo J.Shachter, Ross D.Oliva, Elizabeth M.Henderson, Patricia T.Paik, Meenah C.Trafton, Jodie A.
DGIST Authors
Im, Jinwoo J.
Issue Date
2015-07
Citation
Journal of General Internal Medicine, 30(7), 979-991
Type
Article
Article Type
Article
Keywords
AdultChronic PainClinical Practice GuidelineDisease AssociationDrug ScreeningFemaleFollow UpHealth Care PracticeHumanMajor Clinical StudyMaleMood DisorderOpiateOpioid TherapyPatient RiskPractice GuidelinePrescriptionRetrospective StudyRisk AssessmentSuicide AttemptUnited StatesVeterans Health
ISSN
0884-8734
Abstract
IMPORTANCE: Patients receiving opioid therapy are at elevated risk of attempting suicide. Guidelines recommend practices to mitigate risk, but it is not known whether these are effective. OBJECTIVE: Our aim was to examine associations between the receipt of guideline-recommended care for opioid therapy and risk of suicide attempt. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective analysis of administrative data for all Veteran patients prescribed any short-acting opioids on a chronic basis or any long-acting opioids from the Veterans Health Administration during fiscal year 2010. MAIN OUTCOMES AND MEASURES: Multivariate, mixed-effects logistic regression analyses were conducted to define the associations between the risk of suicide attempt and receipt of guideline-recommended care at the individual level and rates of use of recommended care at the facility level, while accounting for patient risk factors. RESULTS: At the individual level, having a mood disorder was highly associated with suicide attempts (odds ratios [ORs] = 3.5, 3.9; 95 % confidence intervals [CIs] = 3.3–3.9, 3.3–4.6 for chronic short-acting and long-acting groups, respectively). At the facility level, patients on opioid therapy within the facilities ordering more drug screens were associated with decreased risk of suicide attempt (ORs = 0.2, 0.3; CIs = 0.1–0.3, 0.2–0.6 for chronic short-acting and long-acting groups, respectively). In addition, patients on long-acting opioid therapy within the facilities providing more follow-up after new prescriptions were associated with decreased risk of suicide attempt (OR = 0.2, CI = 0.0–0.7), and patients on long-acting opioid therapy within the facilities having higher sedative co-prescription rates were associated with increased risk of suicide attempt (OR = 20.3, CI = 1.1–382.2). CONCLUSIONS AND RELEVANCE: Encouraging facilities to make more consistent use of drug screening, provide follow-up within 4 weeks for patients initiating new opioid prescriptions, and avoid sedative co-prescription in combination with long-acting opioids may help prevent suicide attempts. Some clinicians may selectively employ guideline-recommended practices with at-risk patients. © 2015, Society of General Internal Medicine.
URI
http://hdl.handle.net/20.500.11750/5184
DOI
10.1007/s11606-015-3220-y
Publisher
SPRINGER
Related Researcher
Files:
There are no files associated with this item.
Collection:
School of Undergraduate Studies1. Journal Articles


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