Open Access Open Access  Restricted Access Subscription or Fee Access

Opioid management strategy decreases admissions in high-utilizing adults with sickle cell disease

Amy Mager, PA-C, MPAS, Kristin Pelot, MSSW, Kathryn Koch, APNP, Lawrence Miller, PsyD, Collin Hubler, BS, Anisah Ndifor, BS, Canice Coan, PharmD, Cynthia Leonard, MSN, Joshua J. Field, MD, MS

Abstract


Background: A subset of adults with sickle cell disease (SCD) heavily utilizes the emergency department (ED) and hospital. The objective of our study was to determine the efficacy of a multidisciplinary strategy to address unmet needs in highly utilizing adults with SCD.

Methods: In a prospective study, adults with SCD with 10 admissions per year were assessed by a multidisciplinary team for gaps in medical, social, and psychological care. Thereafter, the team decided upon the subject's predominant domain that drove admissions and instituted an interventional plan. All plans included an opioid management strategy. Preintervention and postintervention admission rate, as well as opioid use, was compared.

Results: Twelve subjects were enrolled. Median rate of ED and hospital admissions preintervention was 25 per year. The predominant domains identified were social needs (n = 6), psychological disorder (n = 1), and substance use disorder (n = 5). Multifaceted interventional plans were developed to address a wide range of gaps in care, but an opioid management strategy was the only intervention successfully completed. Even so, when the preintervention versus postintervention admission rate was compared, regardless of the domain, there was a 40 percent decline in hospital admissions (p = 0.03). Consistent with the successful implementation of an opioid management plan, the decrease in admissions was accompanied by a 37 percent decrease in intravenous opioid use (p = 0.02) and 10 percent decrease in oral opioid use (p = 0.04).

Conclusion: An opioid management strategy, as part of a larger effort to improve care for high-utilizing adults with SCD, decreased rate of admissions and opioid use.


Keywords


sickle cell disease, utilization, opioids, psychological disorder, substance use disorder

Full Text:

PDF

References


Platt OS, Thorington BD, Brambilla DJ, et al.: Pain in sickle cell disease. Rates and risk factors. N E J Med. 1991; 325: 11-16.

Brousseau DC, Owens PL, Mosso AL, et al.: Acute care utilization and rehospitalizations for sickle cell disease. JAMA. 2010; 303: 1288-1294.

Smith WR, Penberthy LT, Bovbjerg VE, et al.: Daily assessment of pain in adults with sickle cell disease. Ann Internal Med. 2008; 148: 94-101.

Koch KL, Karafin MS, Simpson P, et al.: Intensive management of high-utilizing adults with sickle cell disease lowers admissions. Am J Hematol. 2015; 90(3): 215-219.

Ballas SK, Gupta K, Adams-Graves P: Sickle cell pain: a critical reappraisal. Blood. 2012; 120: 3647-3656.

McClish DK, Smith WR, Dahman BA, et al.: Pain site frequency and location in sickle cell disease: The PiSCES project. Pain. 2009; 145: 246-251.

Taylor LE, Stotts NA, Humphreys J, et al.: A review of the literature on the multiple dimensions of chronic pain in adults with sickle cell disease. J Pain Symptom Manage. 2010; 40: 416-435.

Brandow AM, Farley RA, Panepinto JA: Early insights into the neurobiology of pain in sickle cell disease: A systematic review of the literature. Pediatr Blood Cancer. 2015; 62: 1501-1511.

Aisiku IP, Smith WR, McClish DK, et al.: Comparisons of high versus low emergency department utilizers in sickle cell disease. Ann Emerg Med. 2009; 53: 587-593.

Levenson JL, McClish DK, Dahman BA, et al.: Depression and anxiety in adults with sickle cell disease: The PiSCES project. Psychosom Med. 2008; 70: 192-196.

Elander J, Lusher J, Bevan D, et al.: Understanding the causes of problematic pain management in sickle cell disease: Evidence that pseudoaddiction plays a more important role than genuine analgesic dependence. J Pain Symptom Manage. 2004; 27: 156-169.

Haywood C, Jr, Lanzkron S, Bediako S, et al.: Perceived discrimination, patient trust, and adherence to medical recommendations among persons with sickle cell disease. J Gen Intern Med. 2014; 29: 1657-1662.

Benjamin LJ, Swinson GI, Nagel RL: Sickle cell anemia day hospital: An approach for the management of uncomplicated painful crises. Blood. 2000; 95: 1130-1136.

Lanzkron S, Carroll CP, Hill P, et al.: Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis. Am J Hematol. 2015; 90: 376-380.

Chou R, Fanciullo GJ, Fine PG, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10: 113-130.

National Heart Lung Blood Institute: Evidence-based management of sickle cell disease: Expert panel report 2014. Available at http://www.nhlbi.nih.gov/health-pro/guidelines/sickle-cell-disease-guidelines/2014. Accessed August 17, 2015.

National Association of Social Workers (NASW): NASW Standards for Social Work Case Management [Brochure]. Washington, DC: NASW Press, 2016.

Millon TAM, Millon C, Meagher S, et al.: Test Manual for the Millon Behavioral Medicine DIagnostic (MBMD). Minneapolis, MN: National Computer Services, 2001.

Edwards R, Telfair J, Cecil H, et al.: Reliability and validity of a self-efficacy instrument specific to sickle cell disease. Behav Res Ther. 2000; 38: 951-963.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association, 2013.

Manchikanti L, Atluri S, Trescot AM, et al.: Monitoring opioid adherence in chronic pain patients: Tools, techniques, and utility. Pain Physician. 2008; 11: S155-S180.

Jencks SF, Williams MV, Coleman EA: Rehospitalizations among patients in the Medicare fee-for-service program. N E J Med. 2009; 360: 1418-1428.

Solomon LR: Treatment and prevention of pain due to vasoocclusive crises in adults with sickle cell disease: An educational void. Blood. 2008; 111: 997-1003.

Robins LN, Helzer JE, Weissman MM, et al.: Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry. 1984; 41: 949-958.




DOI: http://dx.doi.org/10.5055/jom.2017.0382

Refbacks

  • There are currently no refbacks.