Search

Objective Thirty percent of adults with fibromyalgia receive an opioid, but the prevalence of opioid prescribing in pediatric chronic musculoskeletal pain is unknown. The aims of this study were to determine the prevalence of and factors associated with opioid exposure and polypharmacy among children with chronic musculoskeletal pain. Methods In this retrospective cohort study using health care claims data from 2000 to 2013, the index date was the first ICD-9 code 729.1. Included subjects were ≥ 2 and < 18 years old at the index date with two or more codes within 12 months and 18 months of continuous enrollment. Subjects with burns, sickle cell disease, or malignancy were excluded. Opioid exposure was defined as one or more prescriptions within six months before or any time after the index date. Polypharmacy was considered minor (2–4 medications) or major (≥5 medications). Results Of 25,321 included subjects, 20% received an opioid and 26% experienced minor polypharmacy. Opioid exposure was associated with female sex (odds ratio [OR] = 1.27, P  < 0.01), Caucasian race (OR = 1.27, P  < 0.01), hospitalization (OR = 1.20, P  < 0.01), and visit with anesthesiology (OR = 1.97, P  < 0.01) or orthopedics (OR = 1.09, P  < 0.05). Mental health codes were associated with decreased odds of opioid exposure (all P  < 0.05). Children seen by a chiropractor or physiatrist had a reduced odds of receipt of an opioid (OR = 0.42 and 0.84, respectively, both P  < 0.01). Conclusions Twenty percent of children with chronic musculoskeletal pain received an opioid. Twenty-six percent experienced polypharmacy, with the majority receiving 2–4 medications. Increased availability of psychological and nonpharmacologic services are potential strategies to reduce opioid exposure. [ABSTRACT FROM AUTHOR]

Objective: We linked pharmacy dispensing data to clinical data in the electronic health record (EHR) to (1) identify characteristics associated with adherence to methotrexate (MTX) and (2) determine the association between adherence and disease activity in patients with juvenile idiopathic arthritis (JIA)., Methods: We conducted a single-center retrospective cohort study of incident MTX recipients with JIA treated between January 2016 and September 2023 for ≥12 months. Using pharmacy dispensing data, complemented by EHR data, we estimated adherence using medication possession ratios (MPRs) over the first 365 days of treatment. We used Fisher's exact and Wilcoxon rank-sum tests to compare patient characteristics between adherent (MPR ≥80%) and nonadherent (MPR <80%) groups and multivariable linear regression to investigate associations between MPR and active joint count., Results: Among 224 patients, 81 (36.2%) were classified as nonadherent. In bivariate analysis, patients of younger age, of Black race, and from areas with lower child opportunity index were more likely to be classified as nonadherent. In multivariable analysis, active joint count changed from baseline to 12-month follow-up by -0.38 joints in the adherent compared to nonadherent group (95% confidence interval [CI] -0.74 to -0.01) and by -1.18 joints in patients with polyarticular course (95% CI -2.23 to -0.13)., Conclusion: Linking dispense data to clinical EHR data offers a novel, objective method for evaluating adherence to chronic medications. We identified demographic and area-level determinants of adherence, along with small but statistically significant differences in JIA disease activity measures by adherence status. Future work is needed to evaluate adherence as a potential mediator of known outcome disparities for socially disadvantaged populations., (© 2024 The Author(s). Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Competing Interests: The authors declare no conflict of interest.