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Methadone and Cardiac Adverse Outcomes: A Retrospective Study of Patients in a Managed Care Organization (S750)
448
Poster Abstracts
began within 3 days of the start of the beneficiary’s hospice episode and ended within 3 days of the end of the beneficiary’s hospice episode. For 65% of GIP stays, the beneficiary was not in hospice on the day immediately preceding their first GIP day. Nearly 80% of all hospice providers provided at least one GIP day. Most providers billed less than 13% of their hospice days as GIP days (average ¼ 1.5%); a small number exceeded 20%. A higher proportion of older hospices provide GIP than younger hospices, and nearly all large hospices provide GIP compared to half of small hospices. Nearly all New England providers provided GIP vs. three-quarter of Southern providers. Conclusion. There are important variations in GIP utilization by LOS, site of service, and provider characteristics. Most beneficiaries who had a GIP stay began their hospice episode receiving GIP level of care.
Implications for Research, Policy, or Practice. Ongoing analyses seek to better understand the underlying causes of variation and factors that influence transition to GIP.
Methadone and Cardiac Adverse Outcomes: A Retrospective Study of Patients in a Managed Care Organization (S750) Lea Price, PharmD BCPS, Kaiser Permanente, Lafayette, CO. Jeffrey Manuel, MD, Kaiser Permanente, Denver, CO. Deanne Kurz, BA CCRP, Kaiser Permanente, Englewood, CO. Thomas Delate, PhD MS, Kaiser Permanente, Aurora, CO. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. List the risk factors for QTc prolongation and torsades de pointes associated with methadone therapy. 2. Describe the risk factors seen with cardiac events in patients prescribed methadone for pain management. Background. Methadone has been shown to cause QTc prolongation and increase the risk for torsades de pointes. Few studies describe potential cardiac events associated with using methadone for pain management. The purpose of this study is to describe both cardiac events and the risk factors for cardiac events in patients prescribed methadone for pain in a managed care setting. Research Objectives. The primary objective is to determine the proportion of methadone
Vol. 45 No. 2 February 2013
patients with cardiac events, at risk for an event, or neither. A cardiac event is defined as either QTc prolongation > 500ms, hospitalization or emergency department (ED) visit for QTc prolongation or torsades de pointes, or cardiac death due to methadone. The secondary objective is to determine risk factors independently related to having an event. Method. A retrospective cohort study of patients 18 years of age or older receiving methadone for pain management from January through December 2010. Patients were followed for 12 months. Administrative databases were used to identify dates for electrocardiograms (ECG), ED visits, hospitalizations, or cardiac death. Data was confirmed via manual chart review. Result. This study included 1246 patients. Preliminary results reveal the median methadone dose was 20 mg per day and average age was 55.9 years. Thirty (2.4%) patients had a cardiac event, 628 (50.4%) patients were at risk for an event, and 588 (47.2%) patients had neither an event nor a risk factor. Doses greater than 100 mg per day and age were associated with an increased risk of an event (OR 6.6, CI: 1.1338.27; OR 1.05, CI: 1.02-1.09; respectively). Conclusion. There were few cardiac events seen over a one year period in patients prescribed methadone. However, many patients remain at risk for a cardiac event.
Implications for Research, Policy, or Practice. Practitioners should be aware of cardiac risk factors associated with methadone.
A Statewide Survey of Adult and Pediatric Outpatient Palliative Care Services (S751) Michael Rabow, MD, University of California at San Francisco, San Francisco, CA. David O’Riordan, PhD, University of California at San Francisco, San Francisco, CA. Steven Pantilat, MD FAAHPM SFHM, University of California at San Francisco, San Francisco, CA. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Describe the current landscape of outpatient palliative care services available at California hospitals 2. Review the typical outpatient service structure and characteristics 3. Highlight differences between adult and pediatric outpatient palliative care practices
Poster Abstracts
began within 3 days of the start of the beneficiary’s hospice episode and ended within 3 days of the end of the beneficiary’s hospice episode. For 65% of GIP stays, the beneficiary was not in hospice on the day immediately preceding their first GIP day. Nearly 80% of all hospice providers provided at least one GIP day. Most providers billed less than 13% of their hospice days as GIP days (average ¼ 1.5%); a small number exceeded 20%. A higher proportion of older hospices provide GIP than younger hospices, and nearly all large hospices provide GIP compared to half of small hospices. Nearly all New England providers provided GIP vs. three-quarter of Southern providers. Conclusion. There are important variations in GIP utilization by LOS, site of service, and provider characteristics. Most beneficiaries who had a GIP stay began their hospice episode receiving GIP level of care.
Implications for Research, Policy, or Practice. Ongoing analyses seek to better understand the underlying causes of variation and factors that influence transition to GIP.
Methadone and Cardiac Adverse Outcomes: A Retrospective Study of Patients in a Managed Care Organization (S750) Lea Price, PharmD BCPS, Kaiser Permanente, Lafayette, CO. Jeffrey Manuel, MD, Kaiser Permanente, Denver, CO. Deanne Kurz, BA CCRP, Kaiser Permanente, Englewood, CO. Thomas Delate, PhD MS, Kaiser Permanente, Aurora, CO. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. List the risk factors for QTc prolongation and torsades de pointes associated with methadone therapy. 2. Describe the risk factors seen with cardiac events in patients prescribed methadone for pain management. Background. Methadone has been shown to cause QTc prolongation and increase the risk for torsades de pointes. Few studies describe potential cardiac events associated with using methadone for pain management. The purpose of this study is to describe both cardiac events and the risk factors for cardiac events in patients prescribed methadone for pain in a managed care setting. Research Objectives. The primary objective is to determine the proportion of methadone
Vol. 45 No. 2 February 2013
patients with cardiac events, at risk for an event, or neither. A cardiac event is defined as either QTc prolongation > 500ms, hospitalization or emergency department (ED) visit for QTc prolongation or torsades de pointes, or cardiac death due to methadone. The secondary objective is to determine risk factors independently related to having an event. Method. A retrospective cohort study of patients 18 years of age or older receiving methadone for pain management from January through December 2010. Patients were followed for 12 months. Administrative databases were used to identify dates for electrocardiograms (ECG), ED visits, hospitalizations, or cardiac death. Data was confirmed via manual chart review. Result. This study included 1246 patients. Preliminary results reveal the median methadone dose was 20 mg per day and average age was 55.9 years. Thirty (2.4%) patients had a cardiac event, 628 (50.4%) patients were at risk for an event, and 588 (47.2%) patients had neither an event nor a risk factor. Doses greater than 100 mg per day and age were associated with an increased risk of an event (OR 6.6, CI: 1.1338.27; OR 1.05, CI: 1.02-1.09; respectively). Conclusion. There were few cardiac events seen over a one year period in patients prescribed methadone. However, many patients remain at risk for a cardiac event.
Implications for Research, Policy, or Practice. Practitioners should be aware of cardiac risk factors associated with methadone.
A Statewide Survey of Adult and Pediatric Outpatient Palliative Care Services (S751) Michael Rabow, MD, University of California at San Francisco, San Francisco, CA. David O’Riordan, PhD, University of California at San Francisco, San Francisco, CA. Steven Pantilat, MD FAAHPM SFHM, University of California at San Francisco, San Francisco, CA. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Describe the current landscape of outpatient palliative care services available at California hospitals 2. Review the typical outpatient service structure and characteristics 3. Highlight differences between adult and pediatric outpatient palliative care practices