Adherence to Opioid Patient Prescriber Agreements at a Safety Net Hospital
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Design
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Completion of PPA
3.3. Non-Adherence to PPA among Patients Who Completed PPA
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Pain Management Agreement
- (1)
- Only Dr. X will prescribe my narcotic painkillers. I will not ask any other doctor at this clinic or outside his clinic to prescribe my narcotic painkillers.
- (2)
- I will fill my narcotic painkillers at only one pharmacy. Name: X. Phone: X.
- (3)
- I will call my doctor if have problems with my narcotic pain killers or new medical problems.
- (4)
- I give permission to my doctor to discuss my test results and treatment with pharmacists or other doctors.
- (5)
- I will not sell my narcotic painkillers with other persons. These medicines can harm someone not accustomed to their effects.
- (6)
- I will not obtain controlled substances from any other people or doctors.
- (7)
- I will be the only person using my medicines and I will use them as prescribed. I may experience “withdrawal” if I run out of or stop my medications.
- (8)
- My doctor may request urine drug screens from time to time. If I have street drugs or drugs in my system that was not prescribed for me, my doctor may refer me for treatment for addiction or discharge me.
- (9)
- I will guard my medicines carefully. At home I will keep my medicines in a safe place, out of site and out of reach of everyone else, mainly children.
- (10)
- I will bring my medicines in their bottles to each doctor’s visit.
- (11)
- My medicines will not be replaced if they are lost, get wet, destroyed or misplaced.
- (12)
- Early refills are not given for any reason. I will not use any more medicines than prescribed. I will remember that no narcotic painkillers take away all pain.
- (13)
- I will be responsible for making sure that I do not run out of my medications on weekends and holidays, because abrupt discontinuation of these medications can cause severe withdrawal syndrome.
- (14)
- If my medical records are requested, as a result of court ordered subpoena or court order. I will no longer have a right to confidentiality of my records.
- (15)
- I must keep my appointments in order to receive my pain medicine. If I miss an appointment. The clinic cannot guarantee that another appointment will be readily available.
- (16)
- I must keep all the appointments (physical therapy, specialist doctors and counselors) that my doctor recommends.
- (17)
- I understand that treatment with narcotic painkillers is on a trial basis. I will obtain more medicine depending on the benefits I show and also what problems develop.
- (18)
- The consent form explains how much relief I can expect from narcotic painkillers and also what kind of side effects they cause.
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PPA Completed | PPA Non-Adherent | ||||
---|---|---|---|---|---|
Demographic Characteristics | Total n = 905 | Yes n = 484 (53.5%) | No n = 421 (46.5%) | Yes n = 50 (10.3%) | No n = 434 (89.7%) |
Age (in years) | |||||
Mean (range) | 55.1 (18–93) | 54.0 (20–89) | 56.3 (18–93) | 53.1 (28–68) | 54.1 (20–89) |
Age (in years) | |||||
<60 | 590 (65.2%) | 337 (69.6%) | 253 (60.1%) | 34 (68.0%) | 303 (69.8%) |
≥60 | 315 (34.8%) | 147 (30.4%) | 168 (39.9%) | 16 (32.0%) | 131 (30.2%) |
Sex, n (%) | |||||
Female | 474 (52.4%) | 237 (49.0%) | 237 (56.3%) | 15 (30.0%) | 222 (51.2%) |
Male | 431 (47.6%) | 247 (51.0%) | 184 (43.7%) | 35 (70.0%) | 212 (48.9%) |
Race/ethnicity, n (%) | |||||
Hispanic, any race | 423 (46.7%) | 204 (42.2%) | 219 (52.0%) | 10 (20.0%) | 194 (44.7%) |
White, non-Hispanic | 202 (22.3%) | 118 (24.4%) | 84 (20.0%) | 11 (22.0%) | 107 (24.7%) |
Black, non-Hispanic | 257 (28.4%) | 152 (31.40%) | 105 (25.0%) | 28 (56.0%) | 124 (28.6%) |
Other race, non-Hispanic | 23 (2.5%) | 10 (2.1%) | 13 (3.1%) | 1 (2.0%) | 9 (2.1%) |
Marital status, n (%) | |||||
Single * | 603 (66.6%) | 330 (68.2%) | 273 (64.9%) | 46 (92.0%) | 284 (65.4%) |
Married | 302 (33.4%) | 154 (31.8%) | 148 (35.2%) | 4 (8.0%) | 150 (34.6%) |
Cancer type, n (%) | |||||
Gastrointestinal | 312 (34.5%) | 158 (32.6%) | 154 (36.6%) | 17 (34.0%) | 141 (32.5%) |
Respiratory | 108 (11.9%) | 64 (13.2%) | 44 (10.5%) | 4 (8.0%) | 60 (13.8%) |
Gynecological | 103 (11.4%) | 50 (10.3%) | 53 (12.6%) | 1 (2.0%) | 49 (11.3%) |
Genitourinary | 96 (10.6%) | 58 (12.0%) | 38 (9.0%) | 8 (16.0%) | 50 (11.5%) |
Breast | 92 (10.1%) | 46 (9.5%) | 46 (10.9%) | 5 (10.0%) | 41 (9.5%) |
Head and neck | 81 (9.0%) | 52 (10.0%) | 29 (6.9%) | 8 (16.0%) | 44 (10.1%) |
Hematological | 57 (6.3%) | 30 (6.2%) | 27 (6.4%) | 2 (4.0%) | 28 (6.4%) |
Other | 56 (6.2%) | 26 (5.4%) | 30 (7.1%) | 5 (10.0%) | 21 (4.8%) |
Cancer stage, n (%) | |||||
Metastatic | 607 (67.1%) | 326 (67.4%) | 281 (66.8%) | 29 (58.0%) | 297 (68.4%) |
Locally advanced | 187 (20.7%) | 102 (21.1%) | 85 (20.2%) | 16 (32.0%) | 86 (19.8%) |
Localized | 90 (9.9%) | 44 (9.1%) | 46 (10.9%) | 5 (10.0%) | 39 (9.0%) |
Recurrent | 15 (1.7%) | 10 (2.1%) | 5 (1.2%) | 0 (0.0%) | 10 (2.3%) |
Advanced | 5 (0.5%) | 2 (0.4%) | 3 (0.7%) | 0 (0.0%) | 2 (0.5%) |
First line | 1 (0.1%) | 0 (0.0%) | 1 (0.2%) | - | - |
Risk factors of NMOU, n (%) | |||||
History of illicit drug use | 160 (17.7%) | 107 (22.1%) | 53 (12.6%) | 29 (58.0%) | 78 (18.0%) |
History of marijuana use | 197 (21.8%) | 135 (27.9%) | 62 (14.8%) | 26 (52.0%) | 109 (25.1%) |
History of tobacco use | 453 (50.1%) | 273 (56.4%) | 180 (42.9%) | 43 (86.0%) | 230 (53.0%) |
History of alcohol use | 172 (19.0%) | 119 (24.6%) | 53 (12.6%) | 18 (36.0%) | 101 (23.3%) |
History of depression | 155 (17.2%) | 91 (18.8%) | 64 (15.2%) | 12 (24.0%) | 79 (18.2%) |
History of bipolar disorder | 23 (2.5%) | 12 (2.5%) | 11 (2.6%) | 3 (6.0%) | 9 (2.1%) |
History of schizophrenia | 8 (0.9%) | 6 (1.2%) | 2 (0.5%) | 3 (6.0%) | 3 (0.7%) |
Family history of illicit drug use | 16 (1.8%) | 10 (2.1%) | 6 (1.4%) | 3 (6.0%) | 7 (1.6%) |
Personal history of criminal activity | 85 (9.4%) | 58 (12.0%) | 27 (6.4%) | 22 (44.0%) | 36 (8.3%) |
Contact with persons involved in criminal activity | 59 (6.5%) | 40 (8.2%) | 19 (4.5%) | 20 (40.0%) | 20 (4.6%) |
Inconsistent pain presentation | 15 (1.7%) | 9 (1.9%) | 6 (1.4%) | 8 (16.0%) | 1 (0.2%) |
Use for non-malignant pain | 36 (4.0%) | 17 (3.5%) | 19 (4.5%) | 7 (14.0%) | 10 (2.3%) |
Others ** | 6 (0.7%) | 4 (0.8%) | 2 (0.5%) | 3 (6.0%) | 1 (0.2%) |
MEDD at consult, median (Q1–Q3) | 30 (10–70) | 40 (14–75) | 30 (5–62) | 30 (10–60) | 40 (15–80) |
ESAS at consult, mean (SD) | |||||
Pain | 5.7 (3.4) | 5.9 (3.4) | 5.4 (3.5) | 7.2 (2.7) | 5.8 (3.4) |
Tiredness | 5.3 (3.4) | 5.2 (3.3) | 5.4 (3.4) | 5.7 (3.0) | 5.1 (3.3) |
Nausea | 2.4 (3.1) | 2.4 (3.0) | 2.5 (3.2) | 3.0 (3.5) | 2.3 (2.9) |
Depression | 2.7 (3.3) | 2.5 (3.1) | 2.9 (3.5) | 3.5 (3.4) | 2.4 (3.1) |
Anxiety | 2.9 (3.5) | 2.8 (3.4) | 3.0 (3.6) | 4.0 (3.5) | 2.7 (3.4) |
Drowsiness | 2.8 (3.3) | 2.6 (3.1) | 3.1 (3.5) | 2.6 (2.9) | 2.6 (3.2) |
Appetite | 3.9 (3.5) | 4.0 (3.5) | 3.8 (3.6) | 5.2 (3.7) | 3.9 (3.4) |
Well-being | 3.7 (3.4) | 3.7 (3.4) | 3.8 (3.5) | 4.1 (3.5) | 3.6 (3.3) |
Shortness of breath | 2.7 (3.3) | 2.8 (3.2) | 2.7 (3.3) | 3.6 (3.3) | 2.7 (3.2) |
Family distress | 2.0 (3.1) | 2.0 (3.1) | 2.1 (3.1) | 3.0 (3.6) | 1.9 (3.0) |
Spiritual distress | 1.3 (2.5) | 1.2 (2.3) | 1.5 (2.7) | 1.5 (2.4) | 1.2 (2.3) |
Constipation | 2.9 (3.5) | 2.9 (3.5) | 2.8 (3.5) | 3.2 (3.7) | 2.9 (3.4) |
Sleep | 4.8 (3.5) | 4.9 (3.5) | 4.7 (3.6) | 6.0 (3.6) | 4.9 (3.5) |
Univariate Analysis | Multivariable Analysis | |||
---|---|---|---|---|
Unadjusted Odds Ratio (95% Confidence Interval) | p-Value | Adjusted Odds Ratio (95% Confidence Interval) | p-Value | |
Age | ||||
<60 years | 1.52 (1.16–2.00) | 0.003 | 1.44 (1.07–1.4) | 0.02 |
≥60 years | Ref | - | ||
Sex | ||||
Male | 1.4 (1.03–1.75) | 0.03 | 1.09 (0.80–1.49) | 0.57 |
Female | Ref | Ref | ||
Race/ethnicity | ||||
White, non-Hispanic | 1.51 (1.08–2.12) | 0.02 | 1.09 (0.74–1.62) | 0.66 |
Black, non-Hispanic | 1.56 (1.14–2.13) | 0.006 | 1.30 (0.91–1.86) | 0.15 |
Other race, non-Hispanic | 0.83 (0.35–1.92) | 0.66 | 0.75 (0.31–1.81) | 0.52 |
Hispanic, any race | Ref | Ref | ||
Marital status | ||||
Single | 1.16 (0.88–1.53) | 0.29 | 0.98 (0.72–1.34) | 0.89 |
Married | Ref | Ref | ||
Cancer stage | ||||
Locally advanced | 1.03 (0.74–1.44) | 0.84 | - | - |
Localized | 0.82 (0.53–1.28) | 0.39 | - | - |
Recurrent | 1.71 (0.58–5.10) | 0.33 | - | - |
Advanced | 0.57 (0.95–3.46) | 0.55 | - | - |
Metastatic | Ref | - | - | - |
Risk factors of NMOU | ||||
History of illicit drug use | 1.97 (1.37–2.81) | <0.001 | 0.99 (0.58–1.67) | 0.96 |
History of marijuana use | 2.23 (1.60–3.12) | <0.001 | 1.33 (0.87–2.02) | 0.18 |
History of tobacco use | 1.73 (1.33–2.25) | <0.001 | 1.27 (0.92–1.77) | 0.15 |
History of alcohol use | 2.26 (1.58–3.22) | <0.001 | 1.72 (1.12–2.64) | 0.01 |
History of depression | 1.29 (0.91–1.83) | 0.16 | - | - |
History of bipolar disorder | 0.95 (0.41–2.17) | 0.89 | - | - |
History of schizophrenia | 2.62 (0.53–13.07) | 0.24 | 1.28 (0.24–6.93) | 0.77 |
Family history of illicit drug use | 1.46 (0.52–4.04) | 0.47 | - | - |
Personal history of criminal activity | 1.98 (1.23–3.19) | 0.005 | 1.24 (0.59–2.60) | 0.56 |
Contact with persons involved in criminal activity | 1.90 (1.08–3.34) | 0.03 | 1.02 (0.47–2.24) | 0.96 |
Inconsistent pain presentation | 1.31 (0.46–3.70) | 0.61 | - | - |
Use for non-malignant pain | 0.77 (0.39–1.50) | 0.44 | 0.57 (0.28–1.19) | 0.13 |
Others ** | 1.74 (0.32–9.56) | 0.52 | - | - |
MEDD at consult only | 1.00 (1.00–1.00) | 0.27 | - | - |
ESAS at consult only | ||||
Pain | 1.05 (1.01–1.09) | 0.02 | 1.03 (0.98–1.07) | 0.21 |
Tiredness | 0.98 (0.94–1.02) | 0.43 | - | - |
Nausea | 0.99 (0.95–1.04) | 0.70 | - | - |
Depression | 0.97 (0.93–1.01) | 0.09 | - | - |
Anxiety | 0.99 (0.95–1.03) | 0.47 | - | - |
Drowsiness | 0.96 (0.92–1.00) | 0.07 | - | - |
Appetite | 1.01 (0.97–1.05) | 0.53 | - | - |
Well-being | 0.99 (0.95–1.03) | 0.62 | - | - |
Shortness of breath | 1.01 (0.97–1.05) | 0.66 | - | - |
Family distress | 0.99 (0.95–1.04) | 0.67 | - | - |
Spiritual distress | 0.95 (0.90–1.00) | 0.07 | - | - |
Constipation | 1.00 (0.97–1.05) | 0.82 | - | - |
Sleep | 1.01 (0.98–1.05) | 0.47 | - | - |
Univariate Analysis | Multivariable Analysis | |||
---|---|---|---|---|
Unadjusted Odds Ratio (95% Confidence Interval) | p-Value | Adjusted Odds Ratio (95% Confidence Interval) | p-Value | |
Age | ||||
<60 years | 0.92 (0.49–1.72) | 0.79 | 0.93 (0.38–2.26) | 0.87 |
≥60 years | Ref | - | ||
Sex | ||||
Male | 2.44 (1.30–4.60) | 0.006 | 3.66 (1.43–9.32) | 0.007 |
Female | Ref | Ref | ||
Race/ethnicity | ||||
White, non-Hispanic | 1.99 (0.82–4.85) | 0.13 | 0.61 (0.19–1.96) | 0.41 |
Black, non-Hispanic | 4.38 (2.06–9.33) | <0.001 | 1.74 (0.65–4.72) | 0.27 |
Other race, non-Hispanic | 2.16 (0.25–18.72) | 0.49 | - | - |
Hispanic, any race | Ref | Ref | ||
Marital status | ||||
Single | 6.07 (2.15–17.20) | 12.23 (2.29–65.45) | 0.003 | |
Married | Ref | Ref | ||
Cancer stage | ||||
Locally advanced | 1.91 (1.00–3.67) | 0.05 | - | - |
Localized | 1.31 (0.48–3.59) | 0.60 | - | - |
Recurrent | - | - | - | - |
Advanced | - | - | - | - |
Metastasis | Ref | - | ||
Risk factors of NMOU | ||||
History of illicit drug use | 6.30 (3.42–11.63) | <0.001 | 1.81 (0.66–4.96) | 0.25 |
History of marijuana use | 3.23 (1.78–5.86) | <0.001 | 1.98 (0.76–5.12) | 0.16 |
History of tobacco use | 5.45 (2.40–12.38) | <0.001 | 3.34 (1.12–9.99) | 0.03 |
History of alcohol use | 1.85 (1.00–3.44) | 0.05 | 0.29 (0.10–0.79) | 0.02 |
History of depression | 1.42 (0.71–2.84) | 0.32 | - | - |
History of bipolar disorder | 3.01 (0.79–11.52) | 0.11 | - | - |
History of schizophrenia | 9.17 (1.80–46.73) | 0.008 | 7.72 (0.94–63.17) | 0.06 |
Family history of illicit drug use | 3.89 (0.97–15.56) | 0.06 | - | - |
Personal history of criminal activity | 8.69 (4.52–16.71) | <0.001 | 0.86 (0.27–2.76) | 0.80 |
Contact with persons involved in criminal activity | 13.8 (6.70–28.41) | <0.001 | 9.86 (2.75–35.38) | <0.001 |
Inconsistent pain presentation | 82.48 (10.07–675.43) | <0.001 | - | - |
Use for non-malignant pain | 6.90 (2.50–19.06) | <0.001 | 7.45 (1.80–30.90) | 0.006 |
Others ** | 27.64 (2.82–271.50) | 0.004 | - | - |
MEDD at consultation | 1.00 (0.99–1.00) | 0.70 | - | - |
ESAS at consult only | ||||
Pain | 1.15 (1.03–1.28) | 0.01 | 1.20 (1.04–1.38) | 0.01 |
Tiredness | 1.05 (0.95–1.16) | 0.32 | - | - |
Nausea | 1.07 (0.97–1.18) | 0.15 | - | - |
Depression | 1.11 (1.02–1.22) | 0.02 | - | - |
Anxiety | 1.11 (1.02–1.21) | 0.02 | - | - |
Drowsiness | 0.99 (0.90–1.10) | 0.92 | - | - |
Appetite | 1.12 (1.02–1.22) | 0.02 | - | - |
Well-being | 1.05 (0.95–1.15) | 0.35 | - | - |
Shortness of breath | 1.09 (1.00–1.20) | 0.06 | - | - |
Family distress | 1.11 (1.02–1.22) | 0.02 | - | - |
Spiritual distress | 1.07 (0.95–1.20) | 0.30 | - | - |
Constipation | 1.02 (0.94–1.12) | 0.59 | - | - |
Sleep | 1.05 (0.96–1.15) | 0.25 | - | - |
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Pacheco, S.; Nguyen, L.M.T.; Halphen, J.M.; Samy, N.N.; Wilson, N.R.; Sattler, G.; Wing, S.E.; Feng, C.; Paulino, R.A.D.; Shah, P.; et al. Adherence to Opioid Patient Prescriber Agreements at a Safety Net Hospital. Cancers 2023, 15, 2943. https://doi.org/10.3390/cancers15112943
Pacheco S, Nguyen LMT, Halphen JM, Samy NN, Wilson NR, Sattler G, Wing SE, Feng C, Paulino RAD, Shah P, et al. Adherence to Opioid Patient Prescriber Agreements at a Safety Net Hospital. Cancers. 2023; 15(11):2943. https://doi.org/10.3390/cancers15112943
Chicago/Turabian StylePacheco, Soraira, Linh M. T. Nguyen, John M. Halphen, Nikitha N. Samy, Nathaniel R. Wilson, Gregory Sattler, Shane E. Wing, Christine Feng, Rex A. D. Paulino, Pulin Shah, and et al. 2023. "Adherence to Opioid Patient Prescriber Agreements at a Safety Net Hospital" Cancers 15, no. 11: 2943. https://doi.org/10.3390/cancers15112943