P37. Prolonged Postoperative Opioid Use in Patients with Serious Mental Illness

P37. Prolonged Postoperative Opioid Use in Patients with Serious Mental Illness

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P37. Prolonged Postoperative Opioid Use in Patients with Serious Mental Illness

Learner category:

• Beginning Level
• Novice Level
• Intermediate Level
• Expert Level

Learning objectives:

• Participants will be able to recognize of addiction, trauma and recovery in our lives
• Participants will be able to recognize the role of our body and mindfulness in a process of change
• Participants will be reflect on the question what can be considered the opposite of addiction
• Participants will be able to recognize the limitations of our current understanding of addiction
• Participants will be able to recognize how mindfulness changes recovery, stigma and our relationships

Abstract

Patients with serious mental illness (SMI; ie major depressive disorder, bipolar disorders, schizophrenia and other psychotic disorders) experience significantly worse health outcomes. Recent studies have identified anxiety and depression as risk factors for prolonged postoperative opioid use (PPOU; opioid prescription fills greater than 90 days after surgery) following major and minor surgical procedures, even among patients who were opioid naïve prior to surgery. PPOU is associated with a greater risk of opioid misuse, addiction and overdose. This outcome is of particular concern for patients with SMI who are more likely to be prescribed anxiolytics/sedative-hypnotics, placing them at increased risk for respiratory depression. Studies on PPOU have been inconsistent in their definitions of SMI and have largely used claims from private payers. This excludes a large portion of patients with SMI, whose financial resources or disability status often prevents them from obtaining private insurance. In the current study, we will establish an opioid-naïve cohort and compare rates of PPOU in patients with SMI to a propensity-matched group of patients without SMI. We will use 2015-2016 data from a national 5% sample of Medicare beneficiaries, linking inpatient and Part D prescription claims. From preliminary analysis of our data, we estimate a sample size of n=8,000 beneficiaries. Final analysis and interpretations will be presented at the conference. Establishing the relationship between SMI and PPOU will guide surgical nurse practitioners in teaching, assessment and prescribing, addictions and mental health nurse practitioners in consultation and bedside nurses in postoperative pain management teaching.

Authors

Elizabeth Nilsen

BSN RN University of Pittsburgh School of Nursing

Elizabeth Nilsen is a PhD/DNP student at the University of Pittsburgh’s School of Nursing. Prior to becoming a nurse, Elizabeth worked as a service coordinator for individuals with serious mental illness (SMI) living in the community. As a bedside nurse on a surgical unit, she noticed a lack of attention to the role that a patient’s mental illness can play in their medical treatment and recovery. Finding a lack of research in psychiatric care during medical/surgical admissions, she chose to pursue a career as a clinical researcher in surgical care and outcomes of patients with SMI. Elizabeth is working with Dr. Ann Mitchell and Dr. Hayley Germack at the University of Pittsburgh to explore factors associated with prolonged postoperative opioid use in patients with serious mental illness. Her research has the potential to support the importance of ambulatory care, as well as preoperative and postoperative care of patients with SMI.

Hayley Germack

PhD MHS RN University of Pittsburgh School of Nursing

Dr. Germack is an Assistant Professor in the Department of Acute & Tertiary Care at the University of Pittsburgh School of Nursing. A behavioral and nursing health services and policy researcher, her interests include the role of the nurse practitioner workforce, rural health, and patient outcomes. Her current work focuses on patients with mental illness and behavioral health disorders and examines: the barriers and facilitators of delivering high quality health services in rural communities; the impact of alternative care delivery models on outcomes; the role of community factors in mediating outcomes; the impact of managed care on outcomes; and trends in psychiatric medication discontinuation amongst pregnant women. She has received institutional, foundation, and Veterans Affairs funding to support her work. Dr. Germack received her BA, BSN, and PhD at the University of Pennsylvania Center for Health Outcomes and Policy Research and her Masters of Health Sciences at Yale University.

Ann Mitchell

PhD RN FIAAN FAAN, University of Pittsburgh School of Nursing

Dr. Ann M. Mitchell is a Professor of Nursing and Psychiatry in the Health and Community Systems Department at the University of Pittsburgh School of Nursing. Dr. Mitchell’s research interests include mental health outcomes related to bereavement; screening, brief intervention, and referral to treatment (SBIRT); and stigma surrounding alcohol and other drug use. She has been funded by the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Disease Control and Prevention (CDC). Currently she is the Principal Investigator on a SAMHSA-funded grant to integrate medication-assisted treatment information into nursing curricula in order to prepare advanced practice registered nurses to apply for the DATA Waiver upon graduation. Dr. Mitchell received her BS and MS in Nursing at the Pennsylvania State University and her PhD at the University of Pittsburgh.