Patient, Provider, and Clinic Characteristics Associated with Opioid and Non-Opioid Pain Prescriptions for Patients Receiving Low Back Imaging in Primary Care.

Abstract

BACKGROUND:

To describe characteristics of patients, providers, and clinics associated with opioid or non-opioid pain medication prescribing patterns for patients who received lower spine imaging in primary care clinics.

METHODS:

In these secondary analyses of the Lumbar Imaging with Reporting of Epidemiology (LIRE) study, a randomized controlled trial conducted in 4 health systems in the United States, we evaluated characteristics associated with receipt of pain medication prescriptions. The outcomes were receipt of prescriptions for opioid or, separately, non-opioid pain medications within 90 days after imaging. Among patients who received opioid or non-opioid prescriptions, we evaluated receipt of multiple prescriptions in the year following imaging. Mixed models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS:

Compared with whites, patients identified as Asian (OR, 0.53; 95% CI, 0.51-0.56), Native Hawaiian/Pacific Islander (OR, 0.73; 95% CI, 0.64-0.83), multiracial (OR, 0.84; 95% CI, 0.71-0.98) or Black (OR, 0.92; 95% CI, 0.89-0.96) had significantly reduced odds for receiving prescriptions for opioids within 90 days. Patients identified as Native American/Alaska Native had greater odds for receiving prescriptions for non-opioid pain medications within 90 days (OR, 1.12; 95% CI, 1.01-1.24). Receipt of pain prescriptions 120 days before imaging was strongly predictive of subsequent receipt of pain prescriptions across all categories.

CONCLUSIONS:

After adjusting for factors that could affect prescribing, the strongest differences observed in pain-medication prescribing were across racial categories and for patients with previous pain prescriptions. Further research is needed to understand these differences and to optimize prescribing.

• Authors: Laura S Gold, Zachary A Marcum, Eric N Meier, Judith A Turner, Kathryn T James, David F Kallmes, Patrick H Luetmer, Brent Griffith, Karen J Sherman, Janna L Friedly, Pradeep Suri, Richard A Deyo, Sandra K Johnston, Andrew L Avins, Patrick J Heagerty, Jeffrey G Jarvik
• Journal: Journal of the American Board of Family Medicine : JABFM (J Am Board Fam Med) 2021 Sep-Oct Vol. 34 Issue 5 Pg. 950-963 ISSN: 1558-7118 [Electronic] United States
• PMID: 34535520 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
• Copyright: © Copyright 2021 by the American Board of Family Medicine.

Chemical References

• Analgesics, Opioid

Topics

• Analgesics, Opioid (therapeutic use)
• Drug Prescriptions
• Humans
• Pain (drug therapy)
• Practice Patterns, Physicians'
• Primary Health Care
• United States