Analgesic regimens administered to older adults receiving skilled nursing facility care following hip fracture: a proof-of-concept federated analysis.

IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY BMC Geriatrics Pub Date : 2024-10-30 DOI:10.1186/s12877-024-05486-0
Andrew R Zullo, Melissa R Riester, Kaleen N Hayes, Yuan Zhang, Sarah D Berry, Emmanuelle Belanger, Meghan A Cupp, Francesca L Beaudoin
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Abstract

Background: Although a majority of patients in the U.S. receive post-acute care in skilled nursing facilities (SNFs) following hip fracture, large-sample observational studies of analgesic prescribing and use in SNFs have not been possible due to limitations in available data sources. We conducted a proof-of-concept federated analysis of electronic health records (EHRs) from 11 SNF chains to describe analgesic use during hip fracture post-acute care.

Methods: We included residents with a diagnosis of hip fracture between January 1, 2018 and June 30, 2021 who had at least one administration of an analgesic. Use of analgesics was ascertained from EHR medication orders and medication administration records. We quantified the proportion of residents receiving analgesic regimens based on the medications that were administered up to 100 days after hip fracture diagnosis. Plots visualizing trends in analgesic use were stratified by multiple resident characteristics including age and Alzheimer's Disease and Related Dementias (ADRD) diagnosis.

Results: The study included 23,706 residents (mean age 80.5 years, 68.6% female, 87.7% White). Most (~ 60%) residents received opioids + APAP. Monotherapy with APAP or opioids was also common. The most prevalent regimens were oxycodone + APAP (20.1%), hydrocodone + APAP (15.8%), APAP only (15.1%), tramadol + APAP (10.4%), and oxycodone only (4.3%). During the study period, use of APAP-only increased, opioids-only decreased, and opioids + APAP remained stable. Use of APAP-only appeared to be more prevalent among individuals aged > 75 years (versus ≤ 75 years) and those with ADRD (versus without).

Conclusions: We successfully leveraged federated SNF EHR data to describe analgesic use among residents receiving hip fracture post-acute care.

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髋部骨折后接受专业护理机构护理的老年人的镇痛方案:概念验证联合分析。
背景:虽然美国大多数患者在髋部骨折后都会在专业护理机构(SNF)接受急性期后护理,但由于现有数据源的限制,还无法对 SNF 的镇痛剂处方和使用情况进行大样本观察研究。我们对 11 家连锁 SNF 的电子健康记录(EHR)进行了概念验证联合分析,以描述髋部骨折后护理期间镇痛药的使用情况:我们纳入了 2018 年 1 月 1 日至 2021 年 6 月 30 日期间诊断为髋部骨折且至少使用过一次镇痛药的住院患者。镇痛药的使用情况通过电子病历(EHR)用药单和用药管理记录确定。我们根据髋部骨折确诊后 100 天内的用药情况,量化了接受镇痛治疗的住院患者比例。根据居民的多种特征(包括年龄和阿尔茨海默病及相关痴呆症(ADRD)诊断)对镇痛剂使用趋势进行了分层:研究包括 23706 名住院患者(平均年龄 80.5 岁,68.6% 为女性,87.7% 为白人)。大多数居民(约 60%)接受了阿片类药物 + APAP 治疗。使用 APAP 或阿片类药物的单一疗法也很常见。最普遍的治疗方案是羟考酮+APAP(20.1%)、氢可酮+APAP(15.8%)、仅APAP(15.1%)、曲马多+APAP(10.4%)和仅羟考酮(4.3%)。在研究期间,仅使用 APAP 的情况有所增加,仅使用阿片类药物的情况有所减少,而阿片类药物 + APAP 的情况保持稳定。在年龄大于 75 岁(相对于小于 75 岁)和患有 ADRD(相对于无 ADRD)的人群中,仅使用 APAP 似乎更为普遍:我们成功地利用了联合 SNF 电子病历数据来描述接受髋部骨折后期护理的住院患者的镇痛药使用情况。
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来源期刊
BMC Geriatrics
BMC Geriatrics GERIATRICS & GERONTOLOGY-
CiteScore
5.70
自引率
7.30%
发文量
873
审稿时长
20 weeks
期刊介绍: BMC Geriatrics is an open access journal publishing original peer-reviewed research articles in all aspects of the health and healthcare of older people, including the effects of healthcare systems and policies. The journal also welcomes research focused on the aging process, including cellular, genetic, and physiological processes and cognitive modifications.
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