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A minority of opioid users account for most scripts

Plus, preferred SNF networks have fewer readmissions

October 2017
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Published in the October 2017 issue of Today’s Hospitalist

Study: 10% of opioid users 
account for three-fourths of scripts


A SMALL MINORITY of opioid users accounts for the majority of opioid prescriptions. That’s the conclusion of a study that appeared in the Sept. 12 issue of Annals of Internal Medicine. The research found that three-fourths of opioid prescriptions in 2013 were written for only 10% of patients who use them, while 59% of scripts were written for only 5% of users.

Researchers from Stanford and Harvard universities analyzed 2001-13 pharmacy data for more than 19 million Americans with private insurance who filled at least one opioid prescription. By comparison, the authors noted, the top 10% of users in 2001 accounted for 69% of all prescriptions written that year, “suggesting that opioid use became concentrated among fewer users over the study period.”

That 10% translates to about 10 million patients. The findings, the authors write, have key policy implications. Instead of taking a broad, population-wide approach, with restrictions on duration and dosages for all users, policies should instead target the super-users.

Preferred SNF networks
 help cut readmission rates

SNFsHOSPITALS THAT REFER PATIENTS to a preferred network of skilled nursing facilities can expect fewer patients to bounce back to the hospital, according to a new study.

Researchers compared readmission rates at four hospitals that created preferred SNF networks to those of 12 hospitals without preferred networks. Between 2009 and 2013, the hospitals with preferred networks saw readmissions from those SNFs drop 6.1%, while readmission rates from SNFs to comparison hospitals fell only 1.6%. The results appeared in the September issue of Health Affairs.

Study authors also found that hospitals with preferred networks shared several traits. They developed networks with the facilities where many of their patients were already being referred; they collected data from SNFs on measures such as readmission rates and staffing ratios; and they mobilized physician-and-nurse teams to visit patients in SNFs, allowing providers to treat patients in place without sending them back to the hospital.

Only one in three MI survivors 
undergoes cardiac rehab

MIWHILE USE of cardiac rehab among MI patients has been historically low, a new update from the CDC finds that only one-third of all eligible patients receive the therapy.

Researchers relied on phone interviews conducted in 20 states in 2013 and in four states in 2015. They learned that only 33.7% of heart-attack patients in the first round of interviews reported using cardiac rehab and only 35.5% in the second round. Further, the authors found wide variations in use across states, ranging from 20.7% among patients in Hawaii to 58.6% in Minnesota in 2013. Results were published in the Aug. 25 Morbidity and Mortality Weekly Report.

The authors also uncovered significant demographic variations in cardiac-rehab use, with patients more likely to receive cardiac rehab if
they were older, male or non-Hispanic whites, or if they had a college or higher education and two or more risk factors for cardiovascular disease. According to the authors, health systems should “promote cardiac rehab referral and use” and make sure communities have affordable programs.

Older physicians: It’s hard to give up medicine

older physiciansWITH 30% of American doctors age 60 or older, when do they plan to retire? CompHealth, a locum tenens staffing company, surveyed more than 400 doctors age 50 and older and found that respondents didn’t plan to retire until they’re 68. Among the general population in the U.S., average retirement age is 63.

Asked why they wanted to continue working past age 65, 58% said they enjoyed the practice of medicine, 56% enjoyed the social aspects of their practice and 50% wanted to maintain their lifestyle. Half of those surveyed (51%) also reported being interested in working part time after they retire, while 44% wished they had maintained a better work/life balance during their career.

The No. 1 concern respondents listed about retiring was losing the social dynamic of their work. Asked what concerns they have about working beyond full retirement age, 38% worried that they wouldn’t be able to stay competitive in a changing health care environment, while 37% were concerned about declining personal health. In addition, 23% voiced concerns about technology.