OP3-6 - Post-Acute Care Setting after Hip Fracture Hospitalization and Subsequent Opioid Use in Older Adults

Tuesday, April 25, 2023

2:00 PM – 3:30 PM GMT

Presenting Author(s)

Meghan Cupp Buxton, BSc, MPH (she/her/hers)

PhD Candidate
Department of Epidemiology, Brown University School of Public Health
Providence, RI, United States

Author(s)

FB

Francesca L. Beaudoin, MD, PhD

Associate Professor
Department of Epidemiology, Brown University School of Public Health
Providence, RI, United States
Kaleen N. Hayes, PharmD, PhD (she/her/hers)

Assistant Professor
Brown University School of Public Health, Providence, Rhode Island, USA
Brown University
Providence, Rhode Island, United States
MR

Melissa R. Riester, PharmD

Research Scientist
Brown University School of Public Health
Providence, Rhode Island, United States
SB

Sarah Berry, MD, MPH

Associate Professor of Medicine
Department of Medicine, Beth Israel Deaconess Medical Center, United States
RJ

Richa Joshi, MS, MBA

Data Science Analyst
Department of Health Services, Policy, and Practice, Brown University School of Public Health
Providence, United States
Andrew R. Zullo, PharmD, PhD (he/him/his)

Associate Professor
Brown University School of Public Health
Brown University
Providence, RI, United States

ABSTRACT:

Objective: To describe opioid use among older adults following discharge from post-acute care (PAC) for hip fracture in skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs).

Design: Retrospective cohort study.

Setting and Participants: Medicare beneficiaries with Medicare Provider Analysis (MedPAR) claims, aged 66 years and older with a hip fracture hospitalization between 2012 and 2018 followed by PAC in SNFs or IRFs and then discharge to the community.

Methods: Individuals were followed from PAC discharge for up to one year in the community to assess opioid use. Covariate-standardized risk ratios (RR) and risk differences (RD) for opioid use within seven days of PAC discharge were estimated via parametric g-formula with modified Poisson regression models, and hazard ratios (HRs) for any post-PAC opioid use and long-term opioid use via Fine-Gray sub-distribution hazards regression models.

Results: Of 101,021 individuals, 80% (N=80,495) were discharged from SNFs and 20% (N=20,526) from IRFs. Opioids were dispensed to 50,433 patients (50%) overall and the one-year cumulative incidence was notably higher in IRF (68%) than SNF (46%) patients. The adjusted risk of discharge from PAC with an opioid was 41% lower after PAC in SNFs versus IRFs (RR 0.59 [95%CLs 0.57, 0.61] and RD -0.16 [95%CLs -0.17, -0.15]). The adjusted rate of any opioid use in the year after PAC discharge was 44% lower (HR 0.56 [95%CLs 0.54, 0.57]) and of long-term opioid use was 17% lower (HR 0.83 [95%CLs 0.80, 0.87]) among individuals discharged from SNFs versus IRFs.

Conclusions and Implications: Opioid use is highly prevalent upon discharge from PAC after hip fracture hospitalizations, with lower use after SNF versus IRF care. Future research should assess the benefits and harms of post-PAC opioid prescribing and whether care practices during PAC can be improved to optimize long-term opioid use after discharge.