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Table 5 Weighted proportion of inappropriate opioid prescribing practice for patients with or without ADRD by residential setting

From: Quality of opioid prescribing in older adults with or without Alzheimer disease and related dementia

Quality indicators of inappropriate opioid prescribinga Community P-value Nursing home P-value
Weighted proportion among patients with ADRD, % Weighted proportion among patients without ADRD, % Proportion difference (95% CI)b Weighted proportion among patients with ADRD, % Weighted proportion among patients without ADRD, % Proportion difference (95% CI)b
Use of opioids contraindicated for older adults with chronic pain
 Use of meperidine, propoxyphene or partial or mixed opioid agonsists 0.08 0.12 − 0.04 (− 0.06 to − 0.01) < .001 0.05 0.21 − 0.2 (− 0.3 to − 0.03) < .001
Opioid prescribing for opioid-naive patients
 Use of long-acting opioid 0.49 0.62 − 0.13 (− 0.20 to − 0.06) < .001 1.3 1.8 − 0.5 (− 1.0 to 0.04) .070
 Use of high-dose opioid 1.3 2.5 − 1.2 (− 1.3 to − 1.1) < .001 1.9 2.6 − 0.7 (− 1.3 to − 0.05) .035
 Composite of either 1.5 2.8 − 1.3 (− 1.4 to − 1.1) < .001 2.5 3.5 − 1.0 (− 1.7 to − 0.2) .010
Opioid prescribing for patients with neuropathic pain as the index diagnosis
 Long-term use of opioid 21.7 19.5 2.2 (1.3 to 3.1) .003 26.9 36.0 − 9.2 (− 13.6 to − 4.7) < .001
Sensitivity analysis: for patients with neuropathic pain without baseline musculoskeletal or idiopathic pain
 Long-term use of opioid 12.1 10.4 1.8 (0.6 to 2.9) < .001 25.7 33.1 − 7.5 (− 12.1 to − 2.8) < .001
Concurrent use of opioid and CNS depressant for opioid users
 With any qualifying CNS depressantc 44.1 33.3 10.8 (10.2 to 11.4) < .001 58.8 54.1 4.7 (2.8 to 6.6) < .001
 With benzodiazepine 19.5 15.3 4.2 (3.7 to 4.6) < .001 21.0 23.2 − 2.2 (− 3.8 to − 0.6) < .001
 With SSRI or TCA 26.8 19.6 7.2 (6.7 to 7.7) < .001 39.1 38.2 0.96 (− 0.9 to 2.8) .307
 With antipsychotic 10.4 4.6 5.8 (5.4 to 6.1) < .001 26.2 11.4 14.8 (13.5 to 16.1) < .001
 With nonbenzodiazepine 9.5 8.2 1.3 (1.0 to 1.7) < .001 6.7 9.7 − 3.0 (− 4.1 to − 1.9) < .001
Opioid or other scheduled analgesic regimen for moderate to severe paind
 No use of prescription opioide ND ND ND ND 32.7 24.6 8.1 (6.1 to 10.1) < .001
 No use of scheduled pain medicationf ND ND ND ND 47.8 43.1 4.7 (2.4 to 7.0) < .001
 Composite of either ND ND ND ND 60.1 52.5 7.6 (5.3 to 9.9) < .001
  1. Abbreviations: ADRD Alzheimer disease and related dementias, CNS central nervous system, MDS 3.0 Minimum Data Set, version 3.0, MME morphine milligram equivalent, ND not determined, SNRI serotonin-norepinephrine reuptake inhibitor, SSRI selective serotonin reuptake inhibitor, TCA tricyclic antidepressant
  2. aMeasured during the 12 months after diagnosis of chronic pain randomly selected per patient
  3. bProportion difference between ADRD and non-ADRD groups was estimated with generalized linear models along with weight statement (to incorporate inverse probability weighting that balances differences in baseline characteristics between the ADRD and non-ADRD groups)
  4. cCNS-active drugs included antipsychotics, benzodiazepine, nonbenzodiazepine or hypnotics, tricyclic antidepressants, and SNRIs
  5. dDefined as having at least 1 quarterly MDS 3.0 pain assessment with a numeric rating scale score of 4 or more, or moderate or severe pain based on a verbal descriptor scale
  6. eMeasured as having at least 1 quarterly MDS 3.0 moderate to severe pain score without prescription opioids dispensed within 30 days before and after the MDS 3.0 pain assessment
  7. fMeasured as having at least 1 quarterly MDS 3.0 moderate to severe pain score that had no scheduled pain medications (assessed in MDS 3.0 Section J)