Is There a Sequel Out Of Goodwill? Pain Management and Subsequent Opioid Related Hospitalizations

This study investigates the effects of physicians’ prescribing behaviors on the occurrence of opioid related inpatients between 1996 and 2006. Pain management has gradually become more salient since 1990’s, as well as the prevalence of opioid related disorder. The Joint Commission published the first set of standards regarding pain management and treatment in 2001 and included the standards into its healthcare organization performance evaluations. Physicians may respond to the pain management promotion by prescribing more pain relievers. Meanwhile, opioid related hospitalizations in Pennsylvania have significantly increased since early 2000. We investigate whether the change in physicians’ prescribing behaviors in response to the promotion of pain management is related to the increase in opioid related hospitalizations.

We use Pennsylvania Inpatient Discharge Data collected by Pennsylvania Health Care Cost Containment Council (PHC4) to identify non-opioid related inpatients and investigate whether the occurrence of subsequent opioid related hospitalizations was related to physicians’ prescribing behaviors under the differences-in-differences framework. PHC4 Inpatient Discharge Data include almost all inpatients in Pennsylvania and allow us to construct the inpatient history of every patient. We categorize inpatients based on diagnoses because some treatment is accompanied by pain relievers more often the other, in other words, the intensity of pain relievers prescribed varies across diagnosis categories. Physicians may respond to the promotion of pain management differently based on diagnosis categories. The variations in prescription drugs across diagnosis categories identify the change in occurrence of subsequent opioid related hospitalizations related to physicians’ prescribing behaviors.

Since the PHC4 inpatient data do not include prescription information, we use The National Hospital Ambulatory Medical Care Survey (NHAMCS) and The National Ambulatory Medical Care Survey (NAMCS) to construct measures of pain relievers prescribed in all diagnosis categories; and use the measures as the proxies of prescriptions written in non-opioid related inpatients. NHAMCS and NAMCS fit this study well because of its focus on physicians’ behaviors. NHAMCS surveys hospital emergency department (ER), outpatient departments and ambulatory surgery centers, and NAMCS surveys physicians who are considered to have private practice. Both surveys document prescriptions written by physicians instead of medication records reported by patients. NHAMCS and NAMCS document detailed information in prescription drugs and diagnoses of office visits and outpatient visits, which allows us to match prescriptions information with PHC4 Inpatient Discharge Data based on diagnosis categories.