Patterns of opioid utilization in the 90-days post hospital discharge and risk of re-admissions and emergency department visits
Bibliographic record
Abstract
IntroductionOver the past 20 years, increases in opioid prescribing rates and average prescription volumes have been documented in both the United States and Canada. As prescription opioid use and overdose has steadily increased in North America, a dramatic rise in hospitalizations resulting from opioid poisonings has also been witnessed. Objectives and ApproachTo describe opioid utilization patterns for patients admitted to a tertiary care hospital in Montreal between 2014 and 2016, and to estimate the association between opioid use and risk of adverse health outcomes in the 90-days post discharge. Opioid utilization was measured using medication dispensing data from the provincial healthcare databases (RAMQ) while hospital/ED visits were obtained from RAMQ medical services. Patient characteristics and discharge prescriptions were obtained from the hospital chart. Time-varying utilization of opioids was modeled as: 1) current use, 2) cumulative duration of past use, and 3) duration of use of past 10 days, using Cox models. ResultsOf the 3,308 included patients mean age was 70 (SD 14), 57% were male and 47% were discharged from surgical units. 856 (26%) patients had a history of opioid use in the 1-year prior to admission, 1528 (46%) were prescribed an opioid at discharge and 1481 (45%) filled an opioid in the 90-days post discharge. Among patients prescribed an opioid at discharge, 79\% filled their prescription post discharge, where opioid naïve patients were less likely to fill their prescriptions compared to those with a history of opioid use (40% vs 81%). Our multivariable Cox models suggested that cumulative duration of opioid exposure in the past 10 days was associated with a 10% increased risk of ED visits and hospitalizations. Conclusion/ImplicationsPatients with a history of opioid use were more likely to both receive an opioid prescription at hospital discharge and fill their prescription post-discharge. Our findings suggest that longer-term utilization patterns of these medications after hospitalization may increase risk of re-admissions and ED visits.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".