Man practicing walking during physical therapy

Opioids are prescribed at a high rate following post-acute hip fracture stays, a new study has found. But these patients are 41% less likely to receive an opioid prescription at discharge from a skilled nursing facility when compared to patients transitioning from an inpatient rehabilitation facility, investigators say.

Data came from a national cohort of Medicare beneficiaries. Participants were aged 66 years and older and had experienced a hip fracture hospitalization between 2012 and 2018. They then received post-acute care in SNFs or IRFs and were discharged to the community. The patients were followed for up to one year after discharge.

50% leave with a prescription

Across all post-acute facility types, patients were likely to leave with an opioid prescription, the researchers found. Opioids were dispensed in 50% of cases overall.

Notably, fewer SNF patients received opioids during follow-up compared with IRF patients, reported lead author Meghan A. Cupp, MPH, of Brown University School of Public Health in Rhode Island. This difference was in part explained by discharge prescribing patterns, which could be seen in prescriptions given within seven days of leaving the post-acute care facility, she and her colleagues noted.

In addition, the rate of any opioid use in the year after post-acute care facility discharge was 44% lower after SNF discharge than after IRF discharge. What’s more, the rate of long-term opioid use was 17% lower following SNF care versus an IRF stay, Cupp and colleagues reported.

Overtreatment and pain relief

Clinicians walk a fine line when treating pain in post-acute care, where patients are at risk of poor outcomes from both inappropriate opioid use and inadequate pain management, the authors wrote.

The study findings highlight the need to carefully consider the potential benefits and harms of opioid prescribing after a post-acute stay. And the findings raise questions about how care practices might be improved to make the best use of opioids when treating these patients, Cupp and colleagues concluded.

The study was published in JAMDA.

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