Opioid prescribing by dentists for older patients receiving medications with potential contraindications and the subsequent impact on acute care outcomes is not well described.
Our objective was to evaluate the use of potentially inappropriate medication combinations (PIMC) involving opioids prescribed by dentists according to the Beers criteria and risks of 30-day emergency room (ER) visits and all-cause hospitalization among commercially insured dental patients ages 65 years and older.
We conducted a retrospective cohort study of 40,800 older dental patient visits where opioids were prescribed between 2011 and 2015 using the Truven Health MarketScan® databases. Data collection from dental, medical, and pharmacy claims included information on the concurrent use of PIMCs and outcomes of all-cause acute care utilization over the 30-day period after dental encounters.
For the overall cohort, the median age was 69 years, and 45% were female. The prevalence of PIMCs per Beers Criteria was 10.4%. A total of 947 all-cause acute care events were observed in the 30 days post-dental visit. Patients with PIMCs involving opioids prescribed by dentists according to the Beers criteria had higher rates of acute care use (3.3% vs. 2.2%, p<0.001), which were associated with an increased risk of all-cause acute care utilization (adjusted RR 1.23; 95% CI 1.02-1.48). A dose-response relationship was seen with increasing oral morphine equivalents prescribed and increased acute care utilization (P<0.001).
A significant proportion of older patients receiving opioids at dental visits use psychotropic medications that in combination should be avoided according to the American Geriatric Society Beers criteria.
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