| Malpractice claims associated with medication management for chronic pain. | |
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MedLine Citation:
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PMID: 20234314 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Medication management is an integral part of chronic pain management. Prompted by an increase in the role of medication management in anesthesia chronic pain liability, we investigated the characteristics of malpractice claims collected from 2005 to 2008. METHODS: After Institutional Review Board approval, we compared medication management claims with other chronic pain claims from the American Society of Anesthesiologists Closed Claims Database of 8,954 claims. Claims for death underwent in-depth analysis. RESULTS: Medication management represented 17% of 295 chronic non-cancer pain claims. Compared with other chronic pain claims, medication management patients tended to be younger men (P < 0.01) with back pain. Most patients were prescribed opioids (94%) and also additional psychoactive medications (58%). Eighty percent of patients had at least one factor commonly associated with medication misuse and 24% had >or= 3 factors. Most claims (82%) involved patients who did not cooperate in their care (69%) or inappropriate medication management by physicians (59%). Death was the most common outcome in medication management claims (57% vs. 9% in other chronic pain claims, P < 0.01). Factors associated with death included long-acting opioids, additional psychoactive medications, and >or= 3 factors commonly associated with medication misuse. Alleged addiction from prescribed opioids was the complaint in 24%. Appropriateness of care and payments was similar for medication management versus other chronic pain claims. CONCLUSIONS: Most anesthesia malpractice claims for medication management problems involved patients with a history of risk behaviors commonly associated with medication misuse. Malpractice claims arising from medication management had a high proportion of deaths with both patient and physician contributions to the outcome. |
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Authors:
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Dermot R Fitzgibbon; James P Rathmell; Edward Michna; Linda S Stephens; Karen L Posner; Karen B Domino |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesiology Volume: 112 ISSN: 1528-1175 ISO Abbreviation: Anesthesiology Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-04-14 Completed Date: 2010-05-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
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Languages: eng Pagination: 948-56 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA. dermot@u.washington.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Analgesics, Opioid / adverse effects, therapeutic use* Anesthesiology / statistics & numerical data, trends Chronic Disease Databases, Factual Female Humans Insurance, Liability / statistics & numerical data Male Malpractice / legislation & jurisprudence*, statistics & numerical data* Middle Aged Opioid-Related Disorders / epidemiology, mortality Pain / complications, drug therapy*, mortality Psychotropic Drugs / adverse effects, therapeutic use Risk-Taking Treatment Outcome United States Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Opioid; 0/Psychotropic Drugs |
| Comments/Corrections | |
Comment In:
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Anesthesiology. 2010 Apr;112(4):777-8
[PMID:
20216398
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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