Opioid management strategy decreases admissions in high-utilizing adults with sickle cell disease

Authors

  • Amy Mager, PA-C, MPAS
  • Kristin Pelot, MSSW
  • Kathryn Koch, APNP
  • Lawrence Miller, PsyD
  • Collin Hubler, BS
  • Anisah Ndifor, BS
  • Canice Coan, PharmD
  • Cynthia Leonard, MSN
  • Joshua J. Field, MD, MS

DOI:

https://doi.org/10.5055/jom.2017.0382

Keywords:

sickle cell disease, utilization, opioids, psychological disorder, substance use disorder

Abstract

Background: A subset of adults with sickle cell disease (SCD) heavily utilizes the emergency department (ED) and hospital. The objective of our study was to determine the efficacy of a multidisciplinary strategy to address unmet needs in highly utilizing adults with SCD.

Methods: In a prospective study, adults with SCD with 10 admissions per year were assessed by a multidisciplinary team for gaps in medical, social, and psychological care. Thereafter, the team decided upon the subject's predominant domain that drove admissions and instituted an interventional plan. All plans included an opioid management strategy. Preintervention and postintervention admission rate, as well as opioid use, was compared.

Results: Twelve subjects were enrolled. Median rate of ED and hospital admissions preintervention was 25 per year. The predominant domains identified were social needs (n = 6), psychological disorder (n = 1), and substance use disorder (n = 5). Multifaceted interventional plans were developed to address a wide range of gaps in care, but an opioid management strategy was the only intervention successfully completed. Even so, when the preintervention versus postintervention admission rate was compared, regardless of the domain, there was a 40 percent decline in hospital admissions (p = 0.03). Consistent with the successful implementation of an opioid management plan, the decrease in admissions was accompanied by a 37 percent decrease in intravenous opioid use (p = 0.02) and 10 percent decrease in oral opioid use (p = 0.04).

Conclusion: An opioid management strategy, as part of a larger effort to improve care for high-utilizing adults with SCD, decreased rate of admissions and opioid use.

Author Biographies

Amy Mager, PA-C, MPAS

Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

Kristin Pelot, MSSW

Department of Social Services, Froedtert Hospital, Wauwatosa, Wisconsin

Kathryn Koch, APNP

Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

Lawrence Miller, PsyD

Department of Psychology, Rogers Memorial Hospital, West Allis, Wisconsin

Collin Hubler, BS

Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin

Anisah Ndifor, BS

Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

Canice Coan, PharmD

Department of Ambulatory Pharmacy, Froedtert Hospital, Wauwatosa, Wisconsin

Cynthia Leonard, MSN

Department of Ambulatory Nursing, Froedtert Hospital, Wauwatosa, Wisconsin

Joshua J. Field, MD, MS

Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin

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Published

05/01/2017

How to Cite

Mager, PA-C, MPAS, A., K. Pelot, MSSW, K. Koch, APNP, L. Miller, PsyD, C. Hubler, BS, A. Ndifor, BS, C. Coan, PharmD, C. Leonard, MSN, and J. J. Field, MD, MS. “Opioid Management Strategy Decreases Admissions in High-Utilizing Adults With Sickle Cell Disease”. Journal of Opioid Management, vol. 13, no. 3, May 2017, pp. 143-56, doi:10.5055/jom.2017.0382.

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Section

Articles