title: Factors associated with reductions in patients' analgesia at hospital discharge.
abstract: OBJECTIVE
  To describe the patterns of opioid prescribing and the factors associated with reductions in the potency of patients' analgesic medications at the time of hospital discharge.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Two hundred forty-four patients (171 surgical and 73 nonsurgical) hospitalized in an urban academic medical center who have experienced moderate or severe pain and who are taking opioid analgesics prior to discharge.
  
  
  RESULTS
  Step-down (or reduction) in the potency of patients' analgesic medication at the time of discharge. A step-down is defined as the analgesic medication that a patient is prescribed for outpatient analgesia at the time of discharge being less potent then the last pain medication administered to that patient just prior to hospital discharge.
  
  
  RESULTS
  Thirty-three percent of all patients had reductions in the potency of their opioid pain medication at the time of discharge (36% for surgical and 26% for nonsurgical patients). For nonsurgical patients, we found a trend toward Hispanic ethnicity being an independent risk factor for having a step-down in analgesic potency at discharge (odds ratio [OR]: 3.7, 95% confidence interval [CI]: 0.9-14.9).
  
  
  CONCLUSIONS
  Physicians frequently reduce the potency of hospitalized patients' pain medications at discharge and Hispanic patients may be at increased risk of this occurring. Further research is needed to determine if the reductions in analgesic potency we observed are associated with poor posthospital pain outcomes.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. carlton.moore@mssm.edu
authors.forename: Carlton
authors.initials: C
authors.lastname: Moore
authors.forename: Albert
authors.initials: A
authors.lastname: Siu
authors.forename: Catherine
authors.initials: C
authors.lastname: Maroney
authors.forename: Daniel
authors.initials: D
authors.lastname: Fischberg
authors.forename: Ann
authors.initials: A
authors.lastname: Litke
authors.forename: Stacey
authors.initials: S
authors.lastname: Silberzweig
authors.forename: R Sean
authors.initials: RS
authors.lastname: Morrison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D000701:Analgesics, Opioid