Study Finds Evidence of Intentional Inappropriate Painkiller Prescribing

AHRQ Stats: Overdose Deaths Involving Opioids

From 2018 to 2020, the overall rate of drug overdose deaths involving opioids increased from 14.6 per 100,000 population to 21.4. Native Americans experienced the most significant increase, from 13.8 per 100,000 in 2018 to 28.1 in 2020. (Source: AHRQ 2022 National Healthcare Quality and Disparities Report [PDF, 15.5 MB].)

Today's Headlines:

• Study Finds Evidence of Intentional Inappropriate Painkiller Prescribing.
• AHRQ Seeks Research Proposals on Intersection of Climate Change and Healthcare.
• Study Finds Underreporting of Severe Effects of COVID-19 in Children.
• New Systematic Reviews Provide Insights on Use of Telehealth.
• Highlights From AHRQ’s Patient Safety Network.
• Physicians Who Don’t Work in Teams, “Teamlets” Have Lower Burnout Rates.
• AHRQ in the Professional Literature.

Study Finds Evidence of Intentional Inappropriate Painkiller Prescribing

An AHRQ-funded review of painkiller prescriptions suggests that some prescriptions are inappropriately written for patients’ spouses because patients did not fill prescriptions prior to surgery and then are not able to fill the prescriptions themselves afterwards. The study, published in Proceedings of the National Academies of Science, demonstrates that opioid prescriptions are not always written in the name of the patient for whom they are intended. In the study of more than 450,000 couples in which at least one person was prescribed opioids after surgery, researchers found that the rate of opioid prescriptions written for spouses on the day of the surgery was five times as high as the other days around the surgery. The authors said the finding highlights the need for more comprehensive policies and regulations surrounding prescription opioids to improve patient safety. Access the abstract.

AHRQ Seeks Research Proposals on Intersection of Climate Change and Healthcare

A Special Emphasis Notice from AHRQ announces the agency’s interest in receiving health services research grant applications that address the intersection of climate change and healthcare. Primary areas of interest include:

• Reducing the healthcare sector’s greenhouse gas emissions and carbon footprint.
• Creating resilient healthcare systems and communities that can plan for, prepare for, respond to and adapt to climate-related threats.
• Addressing the inequitable impacts of climate change.

The healthcare industry is recognized as not only a responder to climate events, but a significant contributor to climate change through its emissions. Research and action must be guided by an equity lens that prioritizes protecting and empowering individuals and communities that face the highest risks and bear the highest burdens of environmental pollution and a changing climate. To learn more, access the Special Emphasis Notice or contact Brent Sandmeyer, M.P.H., (301) 427-1441, Brent.sandmeyer@ahrq.hhs.gov.

Study Finds Underreporting of Severe Effects of COVID-19 in Children

Multisystem inflammatory syndrome in children (MIS-C), a rare but serious condition that causes severe inflammation of multiple organ systems, was vastly underreported following COVID-19 infection in children, a new AHRQ study has found. In the study, published in JAMA Network Open, researchers used AHRQ’s Healthcare Cost and Utilization Project data to determine that for every five COVID-19 hospitalizations among children, there was one additional hospitalization for MIS-C. The analysis showed MIS-C was more common and severe than initially reported, and with more racial disparities than with COVID-19. Since deaths from MIS-C increase with the number of organ systems affected, researchers concluded that future efforts should focus on how to prevent MIS-C from progressing to multiple organ system dysfunction. Access the abstract.

New Systematic Reviews Provide Insights on Use of Telehealth

Two new systematic reviews from AHRQ’s Effective Health Care Program indicate that remotely delivered medical care, known as telehealth, has benefits for some patients but that factors such as lack of technology and inappropriateness for certain clinical conditions can create barriers to its use.

• Improving Rural Health Through Telehealth-Guided Provider-to-Provider Communication found possible benefits of provider-to-provider telehealth for inpatient care, newborns in rural hospitals, outpatient management of depression and diabetes and some emergency care in rural settings. It also noted that using telehealth for provider education and mentoring might improve patient outcomes, change provider behavior and increase provider knowledge and confidence in treating specific conditions.
• Use of Telehealth During the COVID-19 Era found that telehealth may improve access to care and produce similar clinical outcomes compared with in-person care. However, telehealth may be less suitable and less desirable for patients who have complex clinical conditions or need physical exams, and for therapies requiring the development of rapport between patients and providers.

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

• Accuracy of spinal anesthesia drug concentrations in mixtures prepared by anesthetists.
• A failure in the medication delivery system—how disclosure and systems investigation improve patient safety.
• Scaling-up a pharmacist-led information technology intervention (PINCER) to reduce hazardous prescribing in general practices: multiple interrupted time series study.

Review additional new publications in PSNet’s current issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

Physicians Who Don’t Work in Teams, “Teamlets” Have Lower Burnout Rates

Working in a team or collaboratively with a staff member does not seem to reduce burnout, according to an AHRQ-funded study published in Journal of General Internal Medicine. Researchers explored the use of “teamlets,” where a primary care physician reportedly works with a specific staff member in 80 percent or more of their clinic sessions, and teams, where a physician reportedly works in a practice recognized as a patient-centered medical home. About 77 percent of primary care physicians practiced in a teamlet, 37 percent practiced in a team, 28 percent practiced in both and 14 percent worked independently. The authors linked survey responses from 688 general internists and family physicians to Medicare claims and evaluated several outcome measures, including physician burnout, ambulatory care sensitive emergency department and hospital admissions, and Medicare spending. Contrary to expectations, physicians who practiced independently had significantly lower rates of burnout compared with the three teamlet/team categories. Access the abstract.

AHRQ in the Professional Literature

Advancing diagnostic equity through clinician engagement, community partnerships, and connected care. Giardina TD, Woodard LD, Singh H. J Gen Intern Med 2023 Jan 5. [Epub ahead of print.] Access the abstract on PubMed®.

Association between hospital-physician vertical integration and medication adherence rates. Levin JS, Komanduri S, Whaley C. Health Serv Res 2022 Oct 22. [Epub ahead of print.] Access the abstract on PubMed®.

Telehealth-guided provider-to-provider communication to improve rural health: a systematic review. Totten AM, Womack DM, Griffin JC, et al. J Telemed Telecare 2022 Dec 25. [Epub ahead of print.] Access the abstract on PubMed®.

Pediatric caregiver version of the Shared Decision Making Process Scale: validity and reliability for ADHD treatment decisions. Valentine KD, Lipstein EA, Vo H, et al. Acad Pediatr 2022 Nov-Dec;22(8):1503-9. Epub 2022 Jul 27. Access the abstract on PubMed®.

Impact of patient portal-based self-scheduling of diagnostic imaging studies on health disparities. Ganeshan S, Pierce L, Mourad M, et al. J Am Med Inform Assoc 2022 Nov 14;29(12):2096-2100. Access the abstract on PubMed®.

Implementation of a novel pediatric behavioral health integration initiative. Safon CB, Estela MG, Rosenberg J, et al. J Behav Health Serv Res 2023 Jan;50(1):1-17. Epub 2022 Aug 1. Access the abstract on PubMed®.

Decision-making about clinical trial options among older patients with metastatic cancer who have exhausted standard therapies. Tsang M, DeBoer RJ, Garrett SB, et al. J Geriatr Oncol 2022 Jun;13(5):594-9. Epub 2022 Feb 4. Access the abstract on PubMed®.

A qualitative examination of interprofessional teamwork for infection prevention: development of a model and solutions. Gregory ME, MacEwan SR, Sova LN, et al. Med Care Res Rev 2023 Feb;80(1):30-42. Epub 2022 Jun 25. Access the abstract on PubMed®.