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Deschamps J, Gilbertson J, Straube S, Dong K, MacMaster FP, Korownyk C, Montgomery L, Mahaffey R, Downar J, Clarke H, Muscedere J, Rittenbach K, Featherstone R, Sebastianski M, Vandermeer B, Lynam D, Magnussen R, Bagshaw SM, Rewa OG. Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis. BMC Emerg Med 2021; 21:17. [PMID: 33514325 PMCID: PMC7845034 DOI: 10.1186/s12873-020-00398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Supportive strategies in this population regarding acute healthcare settings may have substantial impact. METHODS We performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a supportive strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of supportive strategies identified. We pooled patient and system related outcome data for each supportive strategy. RESULTS A total of 5664 studies were screened and 19 studies were included. A total of 9 broad categories of supportive strategies were identified. Meta-analysis was performed for the "supports for patients in pain" supportive strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20-0.62], I2 = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61-0.82], I2 = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n = 3, 0.34, 95% CI [0.14-0.82], I2 = 78%). CONCLUSION For patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is "supports for patients in pain".
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Affiliation(s)
- Jean Deschamps
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada.
| | - James Gilbertson
- School of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303 - 112 St NW, Edmonton, Alberta, T6G 2T4, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Frank P MacMaster
- Departments of Psychiatry and Pediatrics, University of Calgary, Strategic Clinical Network for Addictions and Mental Health 2888 Shaganappi Trail NW Calgary, Calgary, Alberta, T3B 6A8, Canada
| | - Christina Korownyk
- Department of Family Medicine, University of Alberta, Suite 205 College Plaza, 8215 112 St NW, Edmonton, Alberta, T6G 2C8, Canada
| | - Lori Montgomery
- Department of Family Medicine, Calgary Chronic Pain Center 1820 Richmond Road SW Calgary, Calgary, Alberta, T2T 5C7, Canada
| | - Ryan Mahaffey
- Department of Anesthesia, University of Ottawa, Ottawa, Ontario, Canada
| | - James Downar
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Ottawa, Ontario, Canada
- Transitional Pain Program, Toronto General Hospital, University Health Network, Ottawa, Ontario, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Katherine Rittenbach
- Addiction & Mental Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Alberta SPOR SUPPORT Unit KT Platform, 4-486D Edmonton Clinical Health Academy, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Meghan Sebastianski
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit Department of Pediatrics, University of Alberta, 362-B Heritage Medical Research Centre (HMRC), Edmonton, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Alberta SPOR SUPPORT Unit KT Platform, 4-486D Edmonton Clinical Health Academy, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Deborah Lynam
- Primary Health Care Information Network, Edmonton, Alberta, Canada
| | - Ryan Magnussen
- Critical Care Strategic Clinical Network, Foothills Medical Centre, ICU Administration - Ground Floor, McCaig Tower, 3134 Hospital Drive, Calgary, Alberta, T2N 2T9, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada
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Deschamps J, Gilbertson J, Straube S, Dong K, MacMaster FP, Korownyk C, Montgomery L, Mahaffey R, Downar J, Clarke H, Muscedere J, Rittenbach K, Featherstone R, Sebastianski M, Vandermeer B, Lynam D, Magnussen R, Bagshaw SM, Rewa OG. Association between harm reduction strategies and healthcare utilization in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:88. [PMID: 30953550 PMCID: PMC6449896 DOI: 10.1186/s13643-019-0997-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/25/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Opioids are routinely used to treat a variety of chronic conditions associated with pain. However, they are a class of medications with a significant potential for adverse health effects, with and without misuse. Opioid misuse, as defined as inappropriate use of appropriately prescribed opioids, is becoming more well-recognized publicly but does not have clear treatment options. Opioid misuse has been linked to variety of poor outcomes and its consequences have a significant impact on healthcare resource utilization. The evidence on harm reduction strategies to mitigate adverse events prompting presentation to acute care settings for patients presenting with long-term opioid use is sparse. METHODS AND ANALYSIS We will perform a systematic review and meta-analysis to catalog effective harm reduction strategies and identify the most effective ones to reduce avoidable healthcare utilization in patients on long-term opioid therapy who present to acute health care settings with complications attributed to opioid misuse. A search strategy will be developed and executed by an information specialist; electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Library) and additional sources will be searched. Search themes will include opioids, chronic drug use, and acute healthcare settings. Citation screening, selection, quality assessment, and data abstraction will be performed in duplicate. A comprehensive inventory of harm reduction strategies will be developed. Data will be collected on patient-related outcomes associated with each identified harm reduction strategy. When sufficiently homogeneous data on interventions, population, and outcomes is available, it will be pooled for aggregate analysis. Evaluation of the methodological quality of individual studies and of the quality of the body of evidence will be performed. Our primary objective will be to identify harm reduction strategies that have been shown to result in clinically relevant and statistically significant improvements in patient outcomes and/or decreased healthcare utilization. DISCUSSION This study will better characterize harm reduction strategies for patients on long-term prescribed opioids presenting to acute healthcare settings. It will also add new knowledge and generate greater understanding of key knowledge gaps of the long-term prescribed opioid use and its impact on healthcare utilization. SYSTEMATIC REVIEW REGISTRATION CRD42018088962 .
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Affiliation(s)
- Jean Deschamps
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E, Clinical Sciences Building, 8440-112 St, Edmonton, NW, T6G 2B7, Canada.
| | - James Gilbertson
- School of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sebastian Straube
- Division of Preventative Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303-112 St. NW, Edmonton, Alberta, T6G 2T4, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Frank P MacMaster
- Departments of Psychiatry and Pediatrics, University of Calgary, Strategic Clinical Network for Addictions and Mental Health, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada
| | - Christina Korownyk
- Department of Family Medicine, University of Alberta, Suite 205 College Plaza, 8215 112 St. NW, Edmonton, Alberta, T6G 2C8, Canada
| | - Lori Montgomery
- Department of Family Medicine, Calgary Chronic Pain Center, 1820 Richmond Road SW, Calgary, Alberta, T2T 5C7, Canada
| | - Ryan Mahaffey
- Department of Anesthesia, University of Ottawa, Ottawa, Ontario, Canada
| | - James Downar
- Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Transitional Pain Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Katherine Rittenbach
- Addiction and Mental Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Alberta,, Canada
- Alberta SPOR SUPPORT Unit KT Platform, Edmonton Clinical Health Academy, 4-486D, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Meghan Sebastianski
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit Department of Pediatrics, University of Alberta, 362-B Heritage Medical Research Centre (HMRC), Alberta, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Alberta,, Canada
- Alberta SPOR SUPPORT Unit KT Platform, Edmonton Clinical Health Academy, 4-486D, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Deborah Lynam
- Primary Health Care Information Network, Edmonton, Alberta, Canada
| | - Ryan Magnussen
- Critical Care Strategic Clinical Network, Foothills Medical Centre, ICU Administration-Ground Floor, McCaig Tower, 3134 Hospital Drive, Calgary, Alberta, T2N 2T9, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E, Clinical Sciences Building, 8440-112 St, Edmonton, NW, T6G 2B7, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E, Clinical Sciences Building, 8440-112 St, Edmonton, NW, T6G 2B7, Canada
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