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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 9 of 9 Research Studies DisplayedYan CH, Hubbard CC, Lee TA
Impact of hydrocodone rescheduling on dental prescribing of opioids.
In 2014, the United States Drug Enforcement Administration rescheduled hydrocodone’s controlled substance schedule from III to II, introducing increasing regulations in prescribing and dispensing. In the U.S., dentists often prescribe hydrocodone, and these changes in scheduling may have altered dental prescribing of opioids. The purpose of this study was to assess the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. Across the 49-month study period, dentists prescribed 50,412,942 opioid prescriptions. Hydrocodone was the most prescribed opioid, followed by codeine, oxycodone, and tramadol. At index, hydrocodone prescribing immediately decreased by -834.8 Rx/1,000 dentists with increased prescribing of codeine, oxycodone, and tramadol. The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period.
AHRQ-funded; HS025177.
Citation: Yan CH, Hubbard CC, Lee TA .
Impact of hydrocodone rescheduling on dental prescribing of opioids.
JDR Clin Trans Res 2023 Oct; 8(4):402-12. doi: 10.1177/23800844221102830..
Keywords: Opioids, Medication, Dental and Oral Health, Practice Patterns
Sankar A, Everhart AO, Jena AB
Longitudinal patterns in testosterone prescribing after US FDA safety communication in 2014.
This study described changes in testosterone prescribing following a 2014 US Food and Drug Administration (FDA) safety communication and how changes varied by physician characteristics. The authors extracted data from a 20% random sample of Medicare fee-for-service administrative claims data from 2011 through 2019. This unique sample included 1,544,604 unique male beneficiaries who received evaluation and management (E&M) services from 58,819 unique physicians that prescribed testosterone between 2011 and 2013. Patients were classified by presence of coronary artery disease (CAD) and non-age-related hypogonadism. Physician characteristics included specialty and affiliations with teaching hospitals, for-profit hospitals, hospitals in integrated delivery networks, and hospitals in the top decile of case mix index. Among 65,089,560 physician-patient-quarter-year observations, mean (standard deviation) age ranged from 72.16 (5.84 SD) years for observations without CAD or non-age-related hypogonadism to 75.73 (6.92 SD) years with CAD and without non-age-related hypogonadism. Following the safety communication, immediate changes in off-label testosterone prescription levels fell by 0.22 percentage points (pp) for patients with CAD and by -0.16 pp for patients without CAD, with a similar change in on-label prescribing levels. The off-label testosterone prescription quarterly trend increased for patients with CAD and without CAD; on-label testosterone prescription trends declined for both groups. Primary care physicians had larger declines in off-label prescribing then non-primary care physicians, and physicians affiliated with teaching compared to nonteaching hospitals. On-label prescribing found no changes associated with physician and organizational characteristics.
AHRQ-funded; HS025164.
Citation: Sankar A, Everhart AO, Jena AB .
Longitudinal patterns in testosterone prescribing after US FDA safety communication in 2014.
Jt Comm J Qual Patient Saf 2023 Sep; 49(9):458-66. doi: 10.1016/j.jcjq.2023.05.003..
Keywords: Communication, Medication, Practice Patterns
Bongiovanni T, Pletcher MJ, Lau C
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has become a foundational strategy to decrease the use of opioids, but data is lacking to describe recommending utilization when admitting patients using electronic health record systems. The purpose of this study was to assess an electronic health record system to increase ordering of NSAIDs for hospitalized adults. The researchers conducted a cluster randomized controlled trial of clinicians admitting adult patients to a health system over a period of 9-months. Clinicians in the intervention arm were required to actively order or decline NSAIDs; the control arm was provided the same order but without a required response. A total of 20,085 hospitalizations were included. The study found that among the hospitalizations, 52% were admitted by a clinician randomized to the intervention arm. NSAIDs were ordered in 22% of the interventions and 22% of the control admissions. There were no statistically significant differences in NSAID administration, pain scores, or opioid prescribing. There were no differences in clinical harms, with average pain scores of 3.36 in the control group and 3.39 in the intervention group, on a scale of 0-5.
AHRQ-funded; HS026383.
Citation: Bongiovanni T, Pletcher MJ, Lau C .
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
J Hosp Med 2023 Aug; 18(8):685-92. doi: 10.1002/jhm.13153..
Keywords: Pain, Opioids, Medication, Behavioral Health, Practice Patterns
Miller-Rosales C, Busch SH, Meara ER
Internal and environmental predictors of physician practice use of screening and medications for opioid use disorders.
This study examined the extent of screening for opioid use and availability of medications for opioid use disorder (MOUD) in a national cross-section of multi-physician primary care and multispecialty practices. The authors found that a total of 26.2% of practices offered MOUD, while 69.4% of practices screened for opioid use. Offering of MOUD in a practice was associated with having advanced HIT functionality, while access to on-site behavioral clinicians was positively associated with offering MOUD in adjusted models.
AHRQ-funded; HS024075.
Citation: Miller-Rosales C, Busch SH, Meara ER .
Internal and environmental predictors of physician practice use of screening and medications for opioid use disorders.
Med Care Res Rev 2023 Aug; 80(4):410-22. doi: 10.1177/10775587231162681..
Keywords: Opioids, Substance Abuse, Behavioral Health, Screening, Medication, Practice Patterns
Gupta N, Kucirka L, Semerjian A
Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States.
The purpose of this study was to describe practice patterns regarding female reproductive organ-sparing (ROS) and nerve-sparing radical cystectomy nerve-sparing radical cystectomy (RC) among US urologists. The researchers conducted a cross-sectional survey of members of the Society of Urologic Oncology to evaluate provider-reported frequency of ROS and nerve-sparing RC in premenopausal and postmenopausal patients with non-muscle-invasive bladder cancer that failed intravesical therapy or clinically localized muscle-invasive bladder cancer. The study found that among 101 urologists, 79.2% reported that they routinely resect the uterus/cervix, 67.3% the neurovascular bundle, 48.5% the ovaries, and 18.8% a portion of the vagina when performing RC in premenopausal patients with organ-confined disease. When asked about changes to approach in postmenopausal patients, 70.3% reported that they were less likely to spare the uterus/cervix, 43.6% were less likely to spare the neurovascular bundle, 69.3% were less likely to spare the ovaries, and 22.8% were less likely to spare a portion of the vagina.
AHRQ-funded; HS026120.
Citation: Gupta N, Kucirka L, Semerjian A .
Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States.
Clin Genitourin Cancer 2023 Aug; 21(4):e236-e41. doi: 10.1016/j.clgc.2023.01.010..
Keywords: Practice Patterns, Women, Sexual Health, Surgery, Cancer
Ramanathan S, Evans CT, Hershow RC
Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints.
The objective of this retrospective study was to compare prescribing of antibiotic prophylaxis in Veterans Affairs (VA) and non-VA settings. Subjects were veteran and non-veteran dental patients with cardiac conditions or prosthetic joints; most were males aged 55 years older. The results showed that VA settings had a higher prevalence of guideline concordant prescribing among those with prosthetic joints, and when assessing dosing errors. The authors recommended that future studies focus on the extent to which integrated electronic health records may be responsible for increased guideline concordant prescribing in the VA setting.
AHRQ-funded; HS025177.
Citation: Ramanathan S, Evans CT, Hershow RC .
Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints.
BMC Infect Dis 2023 Jun 23; 23(1):427. doi: 10.1186/s12879-023-08400-y..
Keywords: Dental and Oral Health, Antibiotics, Medication, Prevention, Cardiovascular Conditions, Practice Patterns
Kim KC, Khouja T, Burgette JM
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
This study examined trends in prescription fills for opioids, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. During this time, 3.8 million children filled prescriptions for high-alert drugs from general dentists. Opioids accounts for 69.4% of high-alert prescriptions, however from 2012 to 2019 fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2%, 43.4%, 43.6% and 89.3%, respectively. Gabapentin prescriptions increased by 8.1%. Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in Southern states were overrepresented among top-prescribing areas in 2019.
AHRQ-funded; HS025177.
Citation: Kim KC, Khouja T, Burgette JM .
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
Pharmacoepidemiol Drug Saf 2023 Jun; 32(6):625-34. doi: 10.1002/pds.5589..
Keywords: Children/Adolescents, Dental and Oral Health, Opioids, Medication, Practice Patterns
Sun EC, Rishel CA, Waljee JF
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
The objective of this study was to examine whether laws limiting opioid prescribing were associated with reductions in the incidence of persistent postoperative opioid use. Over identified 950,000 privately insured patients who had undergone one of 10 procedures were identified; researchers then estimated the association between persistent postoperative opioid use and whether state opioid prescribing limits were in effect on the day of surgery. The findings suggested that laws limiting opioid prescriptions were not associated with subsequent reductions in persistent postoperative opioid use.
AHRQ-funded; HS026753.
Citation: Sun EC, Rishel CA, Waljee JF .
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
Ann Surg 2023 Apr;277(4):e759-e65. doi: 10.1097/sla.0000000000005283.
Keywords: Opioids, Medication, Surgery, Substance Abuse, Practice Patterns
Nguyen T, Meille G, Buchmueller T
AHRQ Author: Meille G
Mandatory prescription drug monitoring programs and overlapping prescriptions of opioids and benzodiazepines: evidence from Kentucky.
This AHRQ-authored study examined how overlapping benzodiazepine and opioid prescription rates changed after Kentucky implemented a PDMP mandate in July 2012 in response to the opioid epidemic. The authors conducted an interrupted time series analysis using monthly data from Kentucky's PDMP from 2010 to 2016. They also conducted an individual-level longitudinal analysis that compared changes in utilization patterns after the mandate went into effect to changes in earlier periods during which the mandate was not in effect. The PDMP mandate was associated with an immediate 7.5 % decline in the rate of overlapping benzodiazepine and opioid prescriptions and a significant change in the trend from increasing to decreasing. A single provider was responsible for approximately half of the immediate effect in level terms who was writing overlapping benzodiazepine and opioid prescriptions. Their longitudinal analysis suggests that over one year the mandate reduced initiation of overlapping prescriptions by 29.3 % and reduced continuation of overlapping prescriptions by 9.4 %, with effects of the policy being largest for women and men aged 36-50.
AHRQ-authored.
Citation: Nguyen T, Meille G, Buchmueller T .
Mandatory prescription drug monitoring programs and overlapping prescriptions of opioids and benzodiazepines: evidence from Kentucky.
Drug Alcohol Depend 2023 Feb 1; 243:109759. doi: 10.1016/j.drugalcdep.2022.109759..
Keywords: Opioids, Medication, Practice Patterns