OPIOID USE AMONG PATIENTS PRESENTING WITH MIGRAINE IN THE EMERGENCY DEPARTMENT
Author(s)
Shah S1, Rascati KL2, Brown CM1, Khan F3, Thach A4, Desai P4
1The University of Texas at Austin, Austin, LA, USA, 2The University of Texas at Austin, Austin, TX, USA, 3Ochsner Neuroscience Institute, New Orleans, LA, USA, 4Amgen Inc., Thousand Oaks, CA, USA
OBJECTIVES: To describe opioid and other acute medication use in patients presenting to the emergency department (ED) with migraine. METHODS: This was a retrospective analysis using electronic medical records (EMRs) from Ochsner Health System, Louisiana from 2011 to 2016. Records were extracted for patients aged > RESULTS: Across 5,948 patients that met inclusion and exclusion criteria during the study period, a total of 15,153 unique ED encounters with a code for migraine were extracted. At least one acute prescription medication was administered in 9,204 (60.7%) of these encounters. Among ED visits for migraine where prescription medication was administered, nearly half (n=4,370/9,204, 47.5%) included at least one opioid. IV hydromorphone was administered in more than half (n=2,473/4,370, 56.6%) of these ED visits. In over one-fourth (n=1,144/4,370, 26.2%) of ED encounters in which an opioid was administered, patients were administered more than one dose of an opioid (i.e., either administration of a different opioid or administration of the same opioid with same or increased dose). Among non-opioid medications (e.g., antiemetics and non-opioid analgesics), antiemetics were the most frequently administered class, given in over one-third of ED (n=3,617/9,204, 39.3%) encounters where acute prescription medication was administered. CONCLUSIONS: Despite best practice guidelines discouraging the use of opioids for migraine, opioids were administered in nearly half of the ED visits, pointing to potentially suboptimal care. Future research focusing on elucidating factors related to clinical decision making in the management of migraine in the ED and barriers to the utilization of effective preventive therapies is needed to reduce opioid overutilization.
Conference/Value in Health Info
2018-05, ISPOR 2018, Baltimore, MD, USA
Value in Health, Vol. 21, S1 (May 2018)
Code
PND51
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Organizational Practices
Topic Subcategory
Academic & Educational, Cost/Cost of Illness/Resource Use Studies, Prescribing Behavior, Treatment Patterns and Guidelines
Disease
Neurological Disorders