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Patients with multiple prescribers more likely to seek ‘high-risk’ prescriptions

Lower continuity of prescribing, as measured by the continuity of care index, was strongly linked to the likelihood for filling high-risk opioid prescriptions or being hospitalized for an opioid-related cause, among patients with long-term opioid use, according to findings recently published in Annals of Family Medicine.

“In an effort to reduce [opioid] risks, clinical guidelines, clinic policies and medication contracts often emphasize continuity of opioid prescribers,” Sara E. Hallvik, MPH, an analytic services manager with HealthInsight Oregon and colleagues wrote.

“Little is known, however, about how prescriber continuity influences risky prescribing patterns or overdose risk, or how the continuity of opioid prescribing compares with other long-term medications,” they added.

Researchers gathered data from Oregon’s Prescription Drug Monitoring Program, including vital records and hospital discharge registry information for 78,056 patients with long-term opioid use for each 6-month period between Oct. 1, 2011, and Sept. 30, 2014. Each patient had a primary prescriber — most categorical prescriptions (eg, opioids) — for each 6-month period of the study identified. Patients were broken up into quartiles of the continuity of care index to examine the probability of these patients having risky prescriptions filled or experiencing opioid-related harms. This index accounted for the total number of prescribers across 6-month timeframes plus the proportion of 6-month timeframes in which a single prescriber was identified as the primary prescriber.

Hallvik and colleagues found patients with greater opioid-prescribing continuity received fewer risky prescriptions than patients in the lowest continuity quartile, and they were less likely to be hospitalized for opioid-related causes. In addition, opioid-related deaths were extremely infrequent and closely mirrored each other among quartiles. Also, patients with long-term opioid use had significantly lower average continuity of care index scores (0.74) vs. those with long-term benzodiazepine use or long-term stimulant use (P = < .0001).

“These results build upon other findings associating long-term opioid use with a larger number of prescribers and adverse outcomes,” Hallvik and colleagues wrote.

“Our data support the clinical importance of continuity in opioid prescribing but suggest that further efforts may be necessary to optimize this continuity. This study also suggests that prescribing continuity can be calculated from pharmacy data using validated continuity of care indices. This application is novel, raising the possibility of measuring prescriber continuity in the absence of medical visit data,” they added. – by Janel Miller

Disclosure: Hallvik reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.