Opioid Utilization and Perception of Pain Control in Hospitalized Patients: A Cross-Sectional Study of 11 Sites in 8 Countries
BACKGROUND: Hospitalized patients are frequently treated with opioids for pain control, and receipt of opioids at hospital discharge may increase the risk of future chronic opioid use.
OBJECTIVE: To compare inpatient analgesic prescribing patterns and patients’ perception of pain control in the United States and non-US hospitals. DESIGN: Cross-sectional observational study.
SETTING: Four hospitals in the US and seven in seven other countries.
PARTICIPANTS: Medical inpatients reporting pain.
MEASUREMENTS: Opioid analgesics dispensed during the first 24-36 hours of hospitalization and at discharge; assessments and beliefs about pain.
RESULTS: We acquired completed surveys for 981 patients, 503 of 719 patients in the US and 478 of 590 patients in other countries. After adjusting for confounding factors, we found that more US patients were given opioids during their hospitalization compared with patients in other countries, regardless of whether they did or did not report taking opioids prior to admission (92% vs 70% and 71% vs 41%, respectively; P < .05), and similar trends were seen for opioids prescribed at discharge. Patient satisfaction, beliefs, and expectations about pain control differed between patients in the US and other sites.
LIMITATIONS: Limited number of sites and patients/country.
CONCLUSIONS: In the hospitals we sampled, our data suggest that physicians in the US may prescribe opioids more frequently during patients’ hospitalizations and at discharge than their colleagues in other countries, and patients have different beliefs and expectations about pain control. Efforts to curb the opioid epidemic likely need to include addressing inpatient analgesic prescribing practices and patients’ expectations regarding pain control.
© 2019 Society of Hospital Medicine
Since 2000, the United States has seen a marked increase in opioid prescribing1-3 and opioid-related complications, including overdoses, hospitalizations, and deaths.2,4,5 A study from 2015 showed that more than one-third of the US civilian noninstitutionalized population reported receiving an opioid prescription in the prior year, with 12.5% reporting misuse, and, of those, 16.7% reported a prescription use disorder.6 While there has been a slight decrease in opioid prescriptions in the US since 2012, rates of opioid prescribing in 2015 were three times higher than in 1999 and approximately four times higher than in Europe in 2015.3,7
Pain is commonly reported by hospitalized patients,8,9 and opioids are often a mainstay of treatment;9,10 however, treatment with opioids can have a number of adverse outcomes.2,10,11 Short-term exposure to opioids can lead to long-term use,12-16 and patients on opioids are at an increased risk for subsequent hospitalization and longer inpatient lengths of stay.5
Physician prescribing practices for opioids and patient expectations for pain control vary as a function of geographic region and culture,10,12,17,18 and pain is influenced by the cultural context in which it occurs.17,19-22 Treatment of pain may also be affected by limited access to or restrictions on selected medications, as well as by cultural biases.23 Whether these variations in the treatment of pain are reflected in patients’ satisfaction with pain control is uncertain.
We sought to compare the inpatient analgesic prescribing practices and patients’ perceptions of pain control for medical patients in four teaching hospitals in the US and in seven teaching hospitals in seven other countries.
METHODS
Study Design
We utilized a cross-sectional, observational design. The study was approved by the Institutional Review Boards at all participating sites.
Setting
The study was conducted at 11 academic hospitals in eight countries from October 8, 2013 to August 31, 2015. Sites in the US included Denver Health in Denver, Colorado; the University of Colorado Hospital in Aurora, Colorado; Hennepin Healthcare in Minneapolis, Minnesota; and Legacy Health in Portland, Oregon. Sites outside the US included McMaster University in Hamilton, Ontario, Canada; Hospital de la Santa Creu i Sant Pau, Universitat Autonòma de Barcelona in Barcelona, Spain; the University of Study of Milan and the University Ospedale “Luigi Sacco” in Milan, Italy, the National Taiwan University Hospital, in Taipei, Taiwan, the University of Ulsan College of Medicine, Asan Medical Center, in Seoul, Korea, the Imperial College, Chelsea and Westminster Hospital, in London, United Kingdom and Dunedin Hospital, Dunedin, New Zealand.
