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Evaluation of Cough Medication Use Patterns in Ambulatory Care Settings in the United States: 2003-2018.

ABSTRACT: Using 2003-2018 National Ambulatory Medical Care Survey data for office-based visits and 2003-2018 National Hospital Ambulatory Medical Care Survey data for emergency department (ED) visits, we conducted cross-sectional analyses to examine cough medication (CM) use trends in the United States (US) ambulatory care settings. We included adult (≥18 years) patient visits with respiratory-infection-related or non-infection-related cough as reason-for-visit or diagnosis without malignant cancer or benign respiratory tumor diagnoses. Using multivariable logistic regressions, we examined opioid antitussive, benzonatate, dextromethorphan-containing antitussive, and gabapentinoid use trends. From 2003-2005 to 2015-2018, opioid antitussive use decreased in office-based visits (8.8% to 6.4%, P_trend = 0.03) but remained stable in ED visits (6.3% to 5.9%, P_trend = 0.99). In both settings, hydrocodone-containing antitussive use declined over 50%. Benzonatate use more than tripled (office-based:1.6% to 4.8%; ED:1.5% to 8.0%; both P_trend < 0.001). Dextromethorphan-containing antitussive use increased in ED visits (1.8% to 2.6%, P_trend = 0.003) but stayed unchanged in office-based visits (3.8% to 2.7%; P_trend = 0.60). Gabapentinoid use doubled in office-based visits (1.1% in 2006-2008 to 2.4% in 2015-2018, P_trend < 0.001) but was negligible in ED visits. In US office-based and ED ambulatory care settings, hydrocodone-containing antitussive use substantially declined from 2003 to 2018, while benzonatate use more than tripled, and dextromethorphan-containing antitussive and gabapentinoid use remained low (<3%).

SUBMITTER: Yang S

PROVIDER: S-EPMC9267927 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVE:To examine the distribution and patterns of opioid prescribing in the United States. DESIGN:Retrospective, observational study. SETTING:National private insurer covering all 50 US states and Washington DC. PARTICIPANTS:An annual average of 669?495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017. MAIN OUTCOME MEASURES:Standardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions. RESULTS:In 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748?000 MMEs-nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years. CONCLUSIONS:Most prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.

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Evaluation of Cough Medication Use Patterns in Ambulatory Care Settings in the United States: 2003-2018.

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