Meta-Analysis

. 2021 Jan 29;21(1):17.

doi: 10.1186/s12873-020-00398-9.

Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis

Jean Deschamps¹, James Gilbertson², Sebastian Straube³, Kathryn Dong⁴, Frank P MacMaster⁵, Christina Korownyk⁶, Lori Montgomery⁷, Ryan Mahaffey⁸, James Downar⁹, Hance Clarke^{10

11}, John Muscedere¹², Katherine Rittenbach^{13

14

15}, Robin Featherstone¹⁶, Meghan Sebastianski¹⁷, Ben Vandermeer¹⁶, Deborah Lynam¹⁸, Ryan Magnussen¹⁹, Sean M Bagshaw²⁰, Oleksa G Rewa²⁰

Affiliations

¹ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada. jean3@ualberta.ca.
² School of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
³ Division of Preventive Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303 - 112 St NW, Edmonton, Alberta, T6G 2T4, Canada.
⁴ Department of Emergency Medicine, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, Alberta, T6G 2R7, Canada.
⁵ Departments of Psychiatry and Pediatrics, University of Calgary, Strategic Clinical Network for Addictions and Mental Health 2888 Shaganappi Trail NW Calgary, Calgary, Alberta, T3B 6A8, Canada.
⁶ Department of Family Medicine, University of Alberta, Suite 205 College Plaza, 8215 112 St NW, Edmonton, Alberta, T6G 2C8, Canada.
⁷ Department of Family Medicine, Calgary Chronic Pain Center 1820 Richmond Road SW Calgary, Calgary, Alberta, T2T 5C7, Canada.
⁸ Department of Anesthesia, University of Ottawa, Ottawa, Ontario, Canada.
⁹ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁰ Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Ottawa, Ontario, Canada.
¹¹ Transitional Pain Program, Toronto General Hospital, University Health Network, Ottawa, Ontario, Canada.
¹² Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
¹³ Addiction & Mental Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada.
¹⁴ Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
¹⁵ Department of Psychiatry, University of Calgary, Calgary, Canada.
¹⁶ Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Alberta SPOR SUPPORT Unit KT Platform, 4-486D Edmonton Clinical Health Academy, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
¹⁷ Knowledge Translation Platform, Alberta SPOR SUPPORT Unit Department of Pediatrics, University of Alberta, 362-B Heritage Medical Research Centre (HMRC), Edmonton, Canada.
¹⁸ Primary Health Care Information Network, Edmonton, Alberta, Canada.
¹⁹ Critical Care Strategic Clinical Network, Foothills Medical Centre, ICU Administration - Ground Floor, McCaig Tower, 3134 Hospital Drive, Calgary, Alberta, T2N 2T9, Canada.
²⁰ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada.

PMID: 33514325
PMCID: PMC7845034
DOI: 10.1186/s12873-020-00398-9

Meta-Analysis

Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis

Jean Deschamps et al. BMC Emerg Med. 2021.

. 2021 Jan 29;21(1):17.

doi: 10.1186/s12873-020-00398-9.

Authors

Affiliations

¹ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada. jean3@ualberta.ca.
² School of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
³ Division of Preventive Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303 - 112 St NW, Edmonton, Alberta, T6G 2T4, Canada.
⁴ Department of Emergency Medicine, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, Alberta, T6G 2R7, Canada.
⁵ Departments of Psychiatry and Pediatrics, University of Calgary, Strategic Clinical Network for Addictions and Mental Health 2888 Shaganappi Trail NW Calgary, Calgary, Alberta, T3B 6A8, Canada.
⁶ Department of Family Medicine, University of Alberta, Suite 205 College Plaza, 8215 112 St NW, Edmonton, Alberta, T6G 2C8, Canada.
⁷ Department of Family Medicine, Calgary Chronic Pain Center 1820 Richmond Road SW Calgary, Calgary, Alberta, T2T 5C7, Canada.
⁸ Department of Anesthesia, University of Ottawa, Ottawa, Ontario, Canada.
⁹ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁰ Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Ottawa, Ontario, Canada.
¹¹ Transitional Pain Program, Toronto General Hospital, University Health Network, Ottawa, Ontario, Canada.
¹² Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
¹³ Addiction & Mental Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada.
¹⁴ Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
¹⁵ Department of Psychiatry, University of Calgary, Calgary, Canada.
¹⁶ Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Alberta SPOR SUPPORT Unit KT Platform, 4-486D Edmonton Clinical Health Academy, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
¹⁷ Knowledge Translation Platform, Alberta SPOR SUPPORT Unit Department of Pediatrics, University of Alberta, 362-B Heritage Medical Research Centre (HMRC), Edmonton, Canada.
¹⁸ Primary Health Care Information Network, Edmonton, Alberta, Canada.
¹⁹ Critical Care Strategic Clinical Network, Foothills Medical Centre, ICU Administration - Ground Floor, McCaig Tower, 3134 Hospital Drive, Calgary, Alberta, T2N 2T9, Canada.
²⁰ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada.

PMID: 33514325
PMCID: PMC7845034
DOI: 10.1186/s12873-020-00398-9

Abstract

Background: Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Supportive strategies in this population regarding acute healthcare settings may have substantial impact.

Methods: We performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a supportive strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of supportive strategies identified. We pooled patient and system related outcome data for each supportive strategy.

Results: A total of 5664 studies were screened and 19 studies were included. A total of 9 broad categories of supportive strategies were identified. Meta-analysis was performed for the "supports for patients in pain" supportive strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20-0.62], I² = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61-0.82], I² = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n = 3, 0.34, 95% CI [0.14-0.82], I² = 78%).

Conclusion: For patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is "supports for patients in pain".

Keywords: Addiction medicine; Drug abuse; Hospital medicine; Opioid; Substance-related disorders.

PubMed Disclaimer

Conflict of interest statement

SMB is supported by a Canada Research Chair in Critical Care Nephrology.

SS has received advisory board fees from Daiichi Sankyo, Inc. SS is a specialist in occupational medicine and some of the patients he assesses have painful conditions.

Figures

**Fig. 1**
Flow diagram for study assessment

**Fig. 2**
Meta-analysis of support for patients in pain supportive interventions for number of ED visits outcome

**Fig. 3**
Meta-analysis of supports for patients in pain supportive interventions for ED discharge opioid prescriptions outcome

See this image and copyright information in PMC

References

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Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis

Affiliations

Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical