Page 34 - Delaware Medical Journal - September/October 2018

TABLE 2: Comparison of opiate prescriptions per patient discharged in an urban and suburban emergency department between May 2012-May 2013
OPIATE PRESCRIPTION PER PATIENT DISCHARGED MAY 1, 2012-APRIL 30, 2013
Urban ED %, (n)
Suburban ED %, (n)
Difference
95% CI
P-value
Opiate prescriptions
16.5 (7164)
22.1 (17546)
5.6%
5.1%, 6.1%
< 0.001
Total patients discharged
43,364
79,346
This correlation has led to further investigation in the prescribing differences between urban and rural areas. However, prior studies describing geographical differences in opiate prescription rates have not been able
to control for different prescribers in each setting, nor have they studied
the suburban population. Our study was performed at a unique healthcare system that includes both an urban
and suburban hospital staffed by the same emergency medicine providers. any literature describing the rate of opiate prescriptions within a suburban population. In addition, there are no studies that utilize the same emergency providers at both the urban and suburban settings. Our study evaluates the number of opioid prescriptions
at discharge from a suburban ED in comparison to those from an urban ED, which are both staffed by the same emergency medicine providers.
METHODS
Study design
This was a descriptive study performed by retrospective electronic medical record review of discharge opiate prescriptions written by the same medical providers in the EDs of a smaller urban and larger suburban hospital over
a one-year time frame (May 1, 2012 to April 30, 2013). The study was submitted and approved by the medical center’s institutional review board (IRB) under usual protocol, with assignment of IRB number 31096 within the institution where the data was collected. After IRB approval was obtained, all ED discharge prescriptions from both hospitals were obtained from the system’s medical branded opioids by name. Additionally, demographic data regarding the two emergency department sites were obtained as outlined in Table 1. Data for both physicians and physician assistants’ prescriptions were combined into one category. A two-proportion z-test
was employed to examine differences between the proportion of opiate prescriptions between the two hospital locations.
Study setting and population
This study was performed in a unique hospital system with two distinct
EDs separated by 10 miles: an urban teaching hospital with an approximate total 2012 ED visit rate of 55,000 patients, and a tertiary community academic suburban level I trauma hospital with a total year ED volume of 115,000 patients. The demographic variation between the two facilities is shown in Table 1. These two hospitals are staffed by the same 50 attending
physicians, 62 resident physicians, and 25 physician assistants. All providers work approximately one-third of their shifts at the urban facility.
RESULTS
Overall, 17,546 opiate prescriptions were written for patients at discharge from the suburban ED, which had a total of 79,346 discharged patients from May 1, 2012 to April 30, 2013. This

total discharge opiate prescriptions written for 43,364 patients discharged from the urban ED over the same time period. At the suburban ED, 22.1% of patients discharged received an opioid prescription, compared to 16.5% of those discharged from the urban ED (5.1%, 6.1%, <0.001) These results are summarized as below in Table 2.
DISCUSSION
This retrospective study reviewed a very large patient population over one year
to determine if there was a difference
in opiate prescribing between an urban and suburban emergency department, both of which are staffed by the same emergency providers. To our knowledge, the differences in prescribing patterns
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Del Med J | September/October 2018 | Vol. 90 | No. 7