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Provider Characteristics are Associated with Prescription of Opioids after Delivery
Abstract Number: S3B-5
Abstract Type: Original Research
Objective: Patient factors are associated with patterns of opioid prescribing after hospitalization, yet factors in the intrapartum and postpartum setting, and in particular, the contribution of provider characteristics, are unclear. The objective of this study was to identify provider and patient characteristics associated with postpartum opioid prescribing patterns at discharge.
Study Design: This was a retrospective case control study of all deliveries at a single, high volume tertiary care center (12/2015-16). Inpatient, outpatient, pharmacy, and billing records were queried for clinical, prescription, and provider (training, academic position, age, and gender) data. The discharging provider, whether an opioid prescription was provided, and the details of the prescription were determined. Multivariable logistic regression with random effects was utilized to identify patient and provider factors independently associated with receipt of a high amount of opioids (morphine milligram equivalents [MME] >90%ile) on discharge analyzed separately for women post vaginal-delivery (VD) and post-cesarean delivery (CD).
Results: 12,362 women were eligible for analysis. Of 9,038 women post-vaginal delivery, 636 (7.04%) received a high MME prescription at discharge, and of 3,288 women post-cesarean delivery, 241 (7.33%) received a high MME prescription. In multivariable analysis, patient factors associated with receipt of a high MME prescription at discharge post-vaginal delivery included nulliparity, operative vaginal delivery, major vaginal laceration, longer postpartum hospitalization, and higher discharge pain score and inpatient MME use. Hispanic race and discharge by a trainee was associated with decreased odds of receiving an opioid prescription. For women post-cesarean delivery, the only patient factors associated with receipt of high MME was other race, PPH, and inpatient MME. However, discharge by a trainee was again associated with decreased odds of being provided a high MME prescription at discharge.
Conclusion: Although patient factors account for some variation in postpartum prescribing of opioids at discharge, discharge by a trainee is significantly associated with a decreased odds of prescribing high MME discharge prescriptions.