Abstract
Background
There is a need to accurately identify patients at risk for drug abuse before giving
a prescription for a scheduled medication.
Objective
Our aim was to describe a subset of emergency department (ED) patients that had eight
or more schedule II−V prescriptions filled from eight or more providers in 1 year,
known as “doctor-shopping” (DS) behavior, to compare demographic features of DS and
non-DS patients, and to determine clinical factors associated with DS.
Methods
We conducted a prospective, observational study of emergency providers' (EPs) assessment
of patients with back pain, dental pain, or headache. EPs recorded patient demographics,
clinical characteristics, and numbers of schedule II−V prescriptions, subset opioid
prescriptions, providers, and pharmacies utilized in a 12-month period, as reported
on the state prescription drug-monitoring program. χ2 and t-tests were used to compare DS with non-DS patients on demographics; a multivariate
logistic regression was performed to determine clinical factors associated with DS.
Results
Five hundred and forty-four patient visits were recorded; 12.3% (n = 67) had DS behavior.
DS and non-DS patients were similar in sex but differed in age, race, chief complaint,
and weekday vs. weekend arrival. DS patients utilized a median of 12.0 (interquartile
range [IQR] 9.0–18.0) providers compared with a median of 1.0 (IQR 0–2.0) providers
in the non-DS group. Reporting allergies to non-narcotic medications (odds ratio [OR] = 3.1;
95% confidence interval [CI] 1.4–6.9; p = 0.01), requesting medications by name (OR = 2.7; 95% CI 1.5–4.9; p < 0.01), and hospital site (OR = 2.0; 95% CI 1.1–3.6; p = 0.03) were significantly associated with DS.
Conclusions
There are multiple clinical characteristics associated with DS in this patient population.
Keywords
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Article info
Publication history
Published online: January 28, 2015
Accepted:
November 16,
2014
Received in revised form:
October 23,
2014
Received:
September 4,
2014
Footnotes
The Institutional Review Board approved this protocol.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
