Opioid dispensation among systemic lupus erythematosus patients who persistently frequent the emergency department

Jiha Lee, MD, MHS; Lisa Gale Suter, MD; Liana Fraenkel, MD, MPH

doi:10.5055/jom.2020.0547

Authors

Jiha Lee, MD, MHS
Lisa Gale Suter, MD
Liana Fraenkel, MD, MPH

DOI:

https://doi.org/10.5055/jom.2020.0547

Keywords:

SLE, opioid, ED utilization, quality of life

Abstract

Objective: To understand prevalence and factors associated with opioid dispensation among systemic lupus erythematosus (SLE) patients who persistently frequent the emergency department (ED) to improve quality of care.

Methods: In this retrospective observational cohort study, the authors identified SLE patients who persistently frequented the ED, defined as having three or more ED visits over 12 months, for at least 2 out of 4 years between 2013 and 2016. The authors collected patient-level variables including demographics and long-term opioid therapy (LTOT). Each encounter was categorized as: SLE-, infection-, pain-related, or “other.” Additional encounter-level variables such as healthcare resource utilization and disposition were recorded. The authors used mixed effects multivariate logistic regression to analyze factors associated with (1) opioid administration in the ED and (2) opioid prescription upon discharge from the ED.

Results: Seventy-seven SLE patients having 1,143 encounters were identified as persistently frequent ED users. Opioids were administered in the ED for 38 percent of all encounters. Medicaid, LTOT, physician as the ED provider versus advanced-practice providers, more imaging tests, and rheumatology specialty consultation were associated with increased odds of opioid administration in the ED. Opioids were prescribed on discharge for 17 percent of encounters discharged from the ED. African American patients, those on Medicaid, and patients utilizing the ED for SLE-related activity/complications compared to “other” reasons were more likely to receive opioid prescription upon discharge from the ED than their respective counterparts.

Conclusion: Opioids are commonly dispensed in the ED for SLE patients. This is true even for patients utilizing the ED for SLE-related disease activity/complications.

Author Biographies

Jiha Lee, MD, MHS

Assistant Professor, Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan. Formerly Assistant Professor, Yale University School of Medicine, New Haven, Connecticut

Lisa Gale Suter, MD

Associate Professor, Yale University School of Medicine, New Haven, Connecticut; Associate Director, Quality Measurement Program, Center for Outcomes Research and Evaluation (CORE), VA Connecticut Healthcare System, West Haven, Connecticut

Liana Fraenkel, MD, MPH

Professor of Medicine, Yale University School of Medicine, New Haven, Connecticut; Section Chief of Rheumatology, CT Veterans Administration Medical Center, VA Connecticut Healthcare System, West Haven, Connecticut

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