EHR data may help identify patients with opioid use disorder
Information available in the electronic health record may help identify patients with opioid use disorder, according to results of a retrospective cross-sectional study published in JAMA Network Open.
“Typically, [opioid use disorder] (OUD) is diagnosed during a patient-physician consultation during which the addiction-trained practitioner uses dialogue with the patient or questionnaires to evaluate whether the patient exhibits symptoms of OUD based on [DSM-5] OUD criteria,” Sarah A. Palumbo, BS, of the department of biomedical science at Schmidt College of Medicine of Florida Atlantic University, and colleagues wrote. “These criteria are based on the assessment of whether opioid use causes significant impairment in physical and social functioning, as well as aspects of craving and unsuccessful efforts to reduce or control use. The presentation of [two] or more of the 11 DSM-5 criteria for OUD within a 12-month period warrants an OUD diagnosis. More important, the practitioner typically relies on the self-report of the patient but may consult a significant other or relative of the patient.”
For frequently underdiagnosed conditions, such as OUD, EHR data may provide significant information, including patients’ demographic characteristics, prescription history and previous health care encounters. This information may be particularly important for consideration within an integrated health care system, where patients seek specialty care and primary care in the same network, according to the investigators.
Palumbo and colleagues aimed to determine whether proxy measures from EHR data could help reliably identify patients with probable OUD according to DSM-5 criteria. They used a mixed-methods approach to analyze data of individuals within a single health system who were prescribed opioids between December 31, 2000, and May 31, 2017. The researchers identified the cohort from 16,253 patients enrolled in a contract-based medication monitoring program for opioid use within the single health system. The cohort included patients who maintained or violated contract terms, as well as a group of 16,254 patients who served as a demographically matched control group and were prescribed opioids but who were not enrolled in the monitoring program. Further, the investigators used automated EHR summaries to assess substance use diagnoses and psychiatric comorbidities. They completed a manual medical record review procedure using DSM-5 criteria for OUD for a subset of patients.
Results showed a significantly lower than expected rate of 2% for OUD diagnoses according to diagnostic codes, which indicated the need for alternative diagnostic strategies. According to the investigators, manual medical record review can be used to assess the DSM-5 criteria for OUD. Results of a manual review of 200 patients in the monitoring program and 200 control patients revealed a larger percentage of patients with probable moderate to severe OUD compared with OUD prevalence assessed using diagnostic codes.
“This study contributes to the growing body of knowledge that emphasizes the utility of EHRs to evaluate a patient’s status or potential for opioid or other substance misuse,” Palumbo and colleagues wrote. “Opioids continue to be used for the treatment of pain. Precision medicine within integrated health systems could be a major associated factor in developing more efficient pain treatments with less risk for addiction, and studies of this potential could be helped by establishing more effective proxy measures for OUD using EHR data.”