Table 1.
Baseline characteristics of cancer patients according to their frequency of emergency department use
| Overall n = 1253 |
Non-Frequent Users (0–3 ED visits) n = 1071 (85.5%) |
Frequent Users (≥ 4 ED visits) n = 182 (14.5%) |
|
|---|---|---|---|
| Patient-related characteristics | |||
| Age at admission (years) | |||
| Mean age (SD) | 70.9 (11.8) | 71.3 (11.8) | 69.1 (11.5) |
| ≤64 | 300 (23.9) | 250 (23.3) | 50 (27.5) |
| >64 | 953 (76.1) | 821 (76.7) | 132 (72.5) |
| N (%) | N (%) | N (%) | |
| Gender | |||
| Female | 532 (42.5) | 459 (42.9) | 73 (40.1) |
| Male | 721 (57.5) | 612 (57.1) | 109 (59.9) |
| Medication copayment plan | |||
| No copayment | 196 (15.6) | 161 (15.0) | 35 (19.2) |
| Partial copayment | 294 (23.5) | 248 (23.2) | 46 (25.3) |
| Maximum copayment | 763 (60.9) | 662 (61.8) | 101 (55.5) |
| Healthcare use in the one year pre-admission period | |||
| Mean (SD) | Mean (SD) | Mean (SD) | |
| Emergency department (ED) visits | 9.2 (14.5) | 8.5 (14.3) | 13.0 (15.5) |
| Hospitalizations | 0.93 (2.21) | 0.89 (2.3) | 1.1 (1.8) |
| Ambulatory visits | 14.5 (12.1) | 14.1 (12.2) | 16.9 (10.9) |
| N (%) | N (%) | N (%) | |
| Radiotherapy | 192 (15.3) | 138 (12.9) | 54 (29.7) |
| Chemotherapy | 239 (19.1) | 168 (15.7) | 71 (39.0) |
| Mean (SD) | Mean (SD) | Mean (SD) | |
| Number of prescribing physicians | 4.8 (3.4) | 4.6 (3.2) | 5.9 (3.9) |
| Number of dispensing pharmacies | 1.4 (0.85) | 1.4 (0.86) | 1.5 (0.81) |
| Active prescriptions at admission | 8.7 (9.7) | 8.5 (9.5) | 10.2 (11.1) |
| Medication use in the one year pre-admission period | |||
| N (%) | N (%) | N (%) | |
| Active opioid prescription at admission | 207 (16.5) | 159 (14.9) | 48 (26.4) |
| History of opioid use | 505 (40.3) | 407 (38.0) | 98 (53.9) |
| History of > 3 opioid dispensations | 45 (3.6) | 37 (3.5) | 8 (4.4) |
| History of analgesics use | 505 (40.3) | 413 (38.6) | 92 (50.6) |
| History of antidepressant use | 270 (21.6) | 226 (21.1) | 44 (24.2) |
| History of benzodiazepines | 503 (40.1) | 403 (37.6) | 100 (54.9) |
| Targeted comorbidities that may increase the risk of hospitalizations/ED visits | |||
| Charlson Comorbidity Index | |||
| 0 | 14 (1.1) | 14 (1.3) | 0 (0) |
| 1–2 | 247 (19.7) | 232 (21.7) | 15 (8.2) |
| ≥3 | 992 (79.2) | 825 (77.0) | 167 (91.8) |
| Cardiovascular Diseases | 602 (48.0) | 508 (47.4) | 94 (51.7) |
| Cerebrovascular Diseases | 114 (9.1) | 92 (8.6) | 22 (12.1) |
| Pneumonia | 124 (9.9) | 101 (9.4) | 23 (12.6) |
| Chronic obstructive pulmonary disease | 349 (27.9) | 292 (27.3) | 57 (31.3) |
| Diabetes | 245 (19.6) | 197 (18.4) | 48 (26.4) |
| Renal Disease | 116 (9.3) | 103 (9.6) | 13 (7.1) |
| History of mental illness | 190 (15.2) | 158 (14.8) | 32 (17.6) |
| History of substance& alcohol abuse | 37 (2.9) | 30 (2.8) | 7 (3.9) |
| History of pain syndromes | 515 (41.1) | 431 (40.2) | 84 (46.2) |
| Cancer diagnoses | |||
| Digestive | 309 (24.7) | 257 (24.0) | 52 (28.6) |
| Lung | 488 (38.9) | 408 (38.1) | 80 (43.9) |
| Breast cancer | 274 (21.9) | 232 (21.7) | 42 (23.1) |
| Urologic | 248 (19.8) | 214 (19.9) | 34 (18.7) |
| Unspecified Cancer | 88 (7.0) | 76 (7.1) | 12 (6.6) |
| In-hospital medication use | |||
| Antidepressants | 220 (17.6) | 184 (17.2) | 36 (19.8) |
| Opioids | 968 (77.3) | 826 (77.1) | 142 (78.0) |
| Benzodiazepines | 855 (68.2) | 731 (68.3) | 124 (68.1) |
| Analgesics | 1163 (92.8) | 993 (92.7) | 170 (93.4) |
| Characteristics of the index hospitalization | |||
| Reasons for admission | |||
| Cancer | 368 (29.5) | 315 (29.5) | 53 (29.3) |
| Respiratory | 201 (16.1) | 180 (16.9) | 21 (11.6) |
| Cardiovascular | 177 (14.2) | 160 (15.0) | 17 (9.4) |
| Digestive | 80 (6.4) | 66 (6.2) | 14 (7.7) |
| Genitourinary | 60 (4.8) | 55 (5.2) | 5 (2.8) |
| Health services (examinations) | 43 (3.5) | 8 (4.4) | 35 (3.3) |
| Infections | 36 (2.9) | 23 (2.2) | 13 (7.2) |
| Musculoskeletal | 29 (2.3) | 25 (2.3) | 4 (2.2) |
| Injection poisonings | 20 (1.6) | 18 (1.7) | 2 (1.1) |
| Dermatological | 20 (1.6) | 16 (1.5) | 4 (2.2) |
| Immune system | 17 (1.4) | 14 (1.3) | 3 (1.7) |
| Metabolic | 16 (1.3) | 9 (0.8) | 7 (3.9) |
| Other 1 | 165 (13.2) | 137 (12.8) | 28 (15.4) |
| Neurological/behavioral | 11 (0.9) | 10 (9.3) | 1 (5.5) |
| Received surgery | 639 (51.0) | 563 (52.6) | 76 (41.7) |
| Type of Surgery Received | |||
| Cardiac | 118 (9.4) | 108 (10.1) | 10 (5.5) |
| Gastrointestinal | 49 (3.9) | 44 (4.1) | 5 (2.8) |
| Thoracic | 417 (33.3) | 358 (33.4) | 59 (32.4) |
| Unrelated | 55 (4.4) | 53 (4.9) | 2 (1.1) |
| Length of hospital stay, days | |||
| Mean (SD) | 8.9 (11.6) | 8.7 (11.7) | 8.6 (11.4) |
| <6 | 166 (13.3) | 143 (13.4) | 23 (12.6) |
| ≥6 | 1087 (86.8) | 928 (86.6) | 159 (87.4) |
| Admission to the ICU | 97 (7.7) | 81 (7.7) | 16 (8.8) |
| Medication reconciliation used | 291 (23.2) | 255 (23.8) | 36 (19.8) |
| Attending physician years of practice | |||
| 1–20 | 350 (27.9) | 291 (27.2) | 59 (32.4) |
| 20–40 | 661 (52.8) | 575 (53.7) | 86 (47.3) |
| >40 | 242 919.3) | 205 (19.1) | 37 (20.3) |
| Discharge prescription signed by | |||
| Attending physician | 280 (22.3) | 241 (22.5) | 39 (21.4) |
| Resident | 973 (77.6) | 830 (77.5) | 143 (78.6) |
| Home discharge destination | |||
| Home | 1147 (91.5) | 975 (91.0) | 172 (94.5) |
| Long-term care facility | 106 (8.5) | 96 (8.9) | 10 (5.5) |
| Pain regimen at discharge | |||
| Opioid prescription | 1017 (81.2) | 870 (81.2) | 147 (80.8) |
| Analgesic prescription | 814 (64.9) | 694 (64.8) | 120 (65.9) |
| Characteristics of the initial opioid dispensation post-discharge 2,3 | |||
| Filled an opioid prescription post-discharge | 475 (37.9) | 357 (33.3) | 118 (64.8) |
| Filled an opioid prescription within 30 days’ post-discharge | 444 (93.5) | 331 (92.7) | 113 (95.8) |
| Filled ≥1 type of opioid | 36 (7.6) | 26 (7.3) | 10 (8.5) |
| MME Dose | |||
| ≤20 | 100 (21.1) | 74 (20.7) | 26 (22.0) |
| 20–50 | 267 (56.2) | 201 (56.3) | 66 (55.9) |
| 50–90 | 93 (19.6) | 73 (20.5) | 20 (16.9) |
| >90 | 15 (3.2) | 9 (2.5) | 6 (5.1) |
| Days’ Supply | |||
| ≤7 | 238 (50.1) | 181 (50.7) | 57 (48.3) |
| >7 | 237 (49.9) | 176 (49.3) | 61 (51.7) |
| Formulation | |||
| Short-acting | 444 (93.5) | 335 (93.8) | 109 (92.4) |
| Long-acting | 31 (6.5) | 22 (6.2) | 9 (7.6) |
| Type of opioid | |||
| Codeine | 10 (2.1) | 9 (1.9) | 1(0.9) |
| Hydromorphone | 151 (31.8) | 104 (29.1) | 47 (39.8) |
| Oxycodone | 272 (57.3) | 215 (60.2) | 57 (48.3) |
| Fentanyl | 9 (1.9) | 8 (2.2) | 1 (0.9) |
| Methadone | 2 (0.4) | 1 (0.3) | 1 (0.9) |
ED = emergency department; SD = standard deviation; ICU = intensive care unit; MME = milligram morphine equivalent
1 Other: pain, vomiting, nausea, dizziness, swelling
2 These numbers are presented only among those who filled an opioid dispensation post-discharge, before their first
ED visit following the index hospitalization (n = 792)
3Percentage of opioid characteristics is calculated based on the total number of patients with at least one dispensation (n = 475)