TY - JOUR
T1 - Detecting aberrant opioid behavior in the emergency department
T2 - a prospective study using the screener and Opioid Assessment for Patients with Pain-Revised (SOAPP®-R), Current Opioid Misuse Measure (COMM)™, and provider gestalt
AU - Varney, Shawn M.
AU - Perez, Crystal A.
AU - Araña, Allyson A.
AU - Carey, Katherine R.
AU - Ganem, Victoria J.
AU - Zarzabal, Lee A.
AU - Ramos, Rosemarie G.
AU - Bebarta, Vikhyat S.
N1 - Funding Information:
Acknowledgements Funding organization: United States Air Force Office of the Surgeon General, October 2012–September 2013.
Funding Information:
Funding organization: United States Air Force Office of the Surgeon General, October 2012?September 2013. The views expressed herein are solely those of the authors and do not represent the official views or policies of the US Government, Department of Defense, or US Air Force. The authors declare that they have no conflict of interest.
Publisher Copyright:
© 2018, SIMI.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Emergency department (ED) providers have limited time to evaluate patients at risk for opioid misuse. A validated tool to assess the risk for aberrant opioid behavior may mitigate adverse sequelae associated with prescription opioid misuse. We sought to determine if SOAPP-R, COMM, and provider gestalt were able to identify patients at risk for prescription opioid misuse as determined by pharmacy records at 12 months. We conducted a prospective observational study of adult patients in a high volume US ED. Patients completed the SOAPP-R and COMM, and treating EM providers evaluated patients’ opioid misuse risk. We performed variable-centered, person-centered, and hierarchical cluster analyses to determine whether provider gestalt, SOAPP-R, or COMM, or a combination, predicted higher misuse risk. The primary outcome was the number of opioid prescriptions at 12 months according to pharmacy records. For 169 patients (mean age 43 years, 51% female, 73% white), correlation analysis showed a strong relationship between SOAPP-R and COMM with predicting the number of opioid prescriptions dispensed at 12 months. Provider scores estimating opioid misuse were not related to SOAPP-R and only weakly associated with COMM. In our adjusted regression models, provider gestalt and SOAPP-R uniquely predicted opioid prescriptions at 6 and 12 months. Using designated cutoff scores, only SOAPP-R detected a difference in the number of opioid prescriptions. Cluster analysis revealed that provider gestalt, SOAPP-R, and COMM scores jointly predicted opioid prescriptions. Provider gestalt and self-report instruments uniquely predicted the number of opioid prescriptions in ED patients. A combination of gestalt and self-assessment scores can be used to identify at-risk patients who otherwise miss the cutoff scores for SOAPP-R and COMM.
AB - Emergency department (ED) providers have limited time to evaluate patients at risk for opioid misuse. A validated tool to assess the risk for aberrant opioid behavior may mitigate adverse sequelae associated with prescription opioid misuse. We sought to determine if SOAPP-R, COMM, and provider gestalt were able to identify patients at risk for prescription opioid misuse as determined by pharmacy records at 12 months. We conducted a prospective observational study of adult patients in a high volume US ED. Patients completed the SOAPP-R and COMM, and treating EM providers evaluated patients’ opioid misuse risk. We performed variable-centered, person-centered, and hierarchical cluster analyses to determine whether provider gestalt, SOAPP-R, or COMM, or a combination, predicted higher misuse risk. The primary outcome was the number of opioid prescriptions at 12 months according to pharmacy records. For 169 patients (mean age 43 years, 51% female, 73% white), correlation analysis showed a strong relationship between SOAPP-R and COMM with predicting the number of opioid prescriptions dispensed at 12 months. Provider scores estimating opioid misuse were not related to SOAPP-R and only weakly associated with COMM. In our adjusted regression models, provider gestalt and SOAPP-R uniquely predicted opioid prescriptions at 6 and 12 months. Using designated cutoff scores, only SOAPP-R detected a difference in the number of opioid prescriptions. Cluster analysis revealed that provider gestalt, SOAPP-R, and COMM scores jointly predicted opioid prescriptions. Provider gestalt and self-report instruments uniquely predicted the number of opioid prescriptions in ED patients. A combination of gestalt and self-assessment scores can be used to identify at-risk patients who otherwise miss the cutoff scores for SOAPP-R and COMM.
KW - Aberrant opioid behavior
KW - Current Opioid Misuse Measure (COMM)
KW - Emergency department
KW - Gestalt
KW - Military
KW - Prescription opioid misuse
KW - Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R)
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UR - http://www.scopus.com/inward/citedby.url?scp=85045140137&partnerID=8YFLogxK
U2 - 10.1007/s11739-018-1804-3
DO - 10.1007/s11739-018-1804-3
M3 - Article
C2 - 29502329
AN - SCOPUS:85045140137
SN - 1828-0447
VL - 13
SP - 1239
EP - 1247
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
IS - 8
ER -