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Opioids or Steroids for Pneumonia or Sinusitis
Karina G Phang1, James R Roberts2, Myla Ebeling2
1Geisinger Medical Center, Danville, Pennsylvania; and kphang@geisinger.edu.
Insights
Children with pneumonia or sinusitis were more likely to receive opioid and corticosteroid prescriptions during emergency department (ED) visits compared to ambulatory care. This highlights a disparity in prescription patterns based on care location for pediatric respiratory infections.
Area of Science:
- Pediatric Medicine
- Pharmacology
- Health Services Research
Background:
- Opioid and corticosteroid prescriptions are common for pediatric respiratory conditions.
- The location of care may influence prescription patterns for these medications.
Purpose of the Study:
- To compare the frequency of opioid and corticosteroid prescriptions for children with pneumonia or sinusitis based on the care setting.
- To investigate potential disparities in medication prescribing for pediatric respiratory infections.
Main Methods:
- Analysis of South Carolina Medicaid claims data from 2016 for children aged 5-18 years.
- Comparison of prescription rates for pneumonia and sinusitis visits across emergency departments (ED), urgent care, and ambulatory settings.
Main Results:
- Children with pneumonia or sinusitis were significantly more likely to receive opioid and corticosteroid prescriptions in the ED compared to ambulatory settings.
- Logistic regression showed increased odds of receiving opioids (aOR 4.69 for pneumonia, 4.02 for sinusitis) and steroids (aOR 1.67 for pneumonia, 3.05 for sinusitis) in the ED.
Conclusions:
- School-aged children receive opioid and steroid prescriptions more frequently in the ED than in ambulatory settings for pneumonia or sinusitis.
- Care location is a significant factor influencing the prescribing of opioids and corticosteroids for common pediatric respiratory conditions.
Objectives:
To compare the frequency of opioid and corticosteroid prescriptions dispensed for children with pneumonia or sinusitis visits on the basis of location of care.
Methods:
We evaluated 2016 South Carolina Medicaid claims data for 5 to 18 years olds with pneumonia or sinusitis. Visits were associated with 1 of 3 locations: the emergency department (ED), urgent care, or the ambulatory setting.
Results:
Inclusion criteria were met by 31 838 children. Pneumonia visits were more often linked to an opioid prescription in the ED (34 of 542 [6.3%]) than in ambulatory settings (24 of 1590 [1.5%]; P ≤ .0001) and were more frequently linked to a steroid prescription in the ED (106 of 542 [19.6%]) than in ambulatory settings (196 of 1590 [12.3%]; P ≤ .0001). Sinusitis visits were more often linked to an opioid prescription in the ED (202 of 2705 [7.5%]) than in ambulatory settings (568 of 26 866 [2.1%]; P ≤ .0001) and were more frequently linked to a steroid prescription in the ED (510 of 2705 [18.9%]) than in ambulatory settings (1922 of 26 866 [7.2%]; P ≤ .0001). In logistic regression for children with pneumonia, the ED setting was associated with increased odds of receiving an opioid (adjusted odds ratio [aOR] 4.69) or steroid (aOR 1.67). Similarly, patients with sinusitis were more likely to be prescribed opioids (aOR 4.02) or steroids (aOR 3.05) in the ED than in ambulatory sites.
Conclusions:
School-aged children received opioid and steroid prescriptions for pneumonia or sinusitis at a higher frequency in the ED versus the ambulatory setting.
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