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Background Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Supportive strategies in this population regarding acute healthcare settings may have substantial impact.
Methods We performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a supportive strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of supportive strategies identified. We pooled patient and system related outcome data for each supportive strategy.
Results A total of 5664 studies were screened and 19 studies were included. A total of 9 broad categories of supportive strategies were identified. Meta-analysis was performed for the “supports for patients in pain” supportive strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20-0.62], I2 = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61-0.82], I2 = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n = 3, 0.34, 95% CI [0.14-0.82], I2 = 78%).
Interpretation For patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is “supports for patients in pain”.
Study registration CRD42018088962
Keywords
Opioid, Addiction Medicine, Substance-Related Disorders, Drug abuse, Hospital Medicine
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This is a list of supplementary files associated with this preprint. Click to download.
- Table1.docx
- Table2.docx
- Table3.docx
- Table4.docx
- AdditionalFile1.docx
Additional File 1 (.docx): Variables extracted from included articles.
- AdditionalFile2.docx
Additional File 2 (.docx): References of included studies
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CURRENT STATUS: Published
View the published article at BMC Emergency Medicine.
No community comments so far
Submission checks complete
On 18 Dec, 2020
Editorial decision: Accept
On 13 Dec, 2020
Version 2
Posted 16 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 01 Dec, 2020
Review #2 received
Received 23 Nov, 2020
Reviewer #2 agreed
On 21 Oct, 2020
Reviewer #1 agreed
On 18 Sep, 2020
Review #1 received
Received 18 Sep, 2020
Editor assigned
On 14 Sep, 2020
Reviewers invited
Invitations sent on 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
No comments provided
Editorial decision: Major revision
On 13 Aug, 2020
Review #2 received
Received 02 Aug, 2020
Reviewer #2 agreed
On 22 Jun, 2020
Review #1 received
Received 06 Jun, 2020
Reviewer #1 agreed
On 02 Jun, 2020
Reviewers invited
Invitations sent on 28 May, 2020
Editor assigned
On 13 May, 2020
Submission checks complete
On 12 May, 2020
Editor invited
On 12 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Emergency Medicine.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Emergency Medicine.
No community comments so far
Submission checks complete
On 18 Dec, 2020
Editorial decision: Accept
On 13 Dec, 2020
Version 2
Posted 16 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 01 Dec, 2020
Review #2 received
Received 23 Nov, 2020
Reviewer #2 agreed
On 21 Oct, 2020
Reviewer #1 agreed
On 18 Sep, 2020
Review #1 received
Received 18 Sep, 2020
Editor assigned
On 14 Sep, 2020
Reviewers invited
Invitations sent on 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
No comments provided
Editorial decision: Major revision
On 13 Aug, 2020
Review #2 received
Received 02 Aug, 2020
Reviewer #2 agreed
On 22 Jun, 2020
Review #1 received
Received 06 Jun, 2020
Reviewer #1 agreed
On 02 Jun, 2020
Reviewers invited
Invitations sent on 28 May, 2020
Editor assigned
On 13 May, 2020
Submission checks complete
On 12 May, 2020
Editor invited
On 12 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Emergency Medicine.
Background Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Supportive strategies in this population regarding acute healthcare settings may have substantial impact.
Methods We performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a supportive strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of supportive strategies identified. We pooled patient and system related outcome data for each supportive strategy.
Results A total of 5664 studies were screened and 19 studies were included. A total of 9 broad categories of supportive strategies were identified. Meta-analysis was performed for the “supports for patients in pain” supportive strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20-0.62], I2 = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61-0.82], I2 = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n = 3, 0.34, 95% CI [0.14-0.82], I2 = 78%).
Interpretation For patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is “supports for patients in pain”.
Study registration CRD42018088962
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
- Table1.docx
- Table2.docx
- Table3.docx
- Table4.docx
- AdditionalFile1.docx
Additional File 1 (.docx): Variables extracted from included articles.
- AdditionalFile2.docx
Additional File 2 (.docx): References of included studies
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