More using strong painkillers

Excerpts from the Globe's blog on the Boston-area medical community.

More than 10 million Americans are taking opioid medications to treat their pain, and more than 4 million of them use the powerful painkillers regularly, a survey by Boston researchers found.

Writing in an upcoming issue of the journal Pain, lead author Judith Parsells Kelly of Boston University School of Medicine reports on random telephone surveys of more than 19,000 adults from 1998 through 2006. While opioid drugs such as oxycodone and methadone are effective at controlling pain, they have also been implicated in overdoses, theft, and "doctor-shopping" by people who become addicted. Kelly and her colleagues set out to measure the prevalence of opioid use among people outside hospitals, data they said were lacking in recent years.

In 2006, 2.2 percent of people responding to the survey said they took opioids at least five days a week for the past month, compared with 1.6 percent in 1998. Half of these regular users had been taking the drugs that often for two years or more, and one-fifth said they had been taking them for at least five years. An additional 2.9 percent of respondents said they used opioids less than five days a week over the past month.

The results translate into 10 million taking opioids and 4.3 million taking them regularly.

People who were taking opioid pain relievers were also likely to be taking other medications, including milder painkillers, antidepressants, or other treatments for chronic conditions.

"Given the large number of individuals affected, the recent increase in public health concern for safe and effective pain management is appropriate," the authors write.

Data collection was funded by BU's Slone Epidemiology Center, and data analysis was supported by GlaxoSmithKline.

Surveyors from the national accrediting organization known as the Joint Commission showed up at Tufts Medical Center on a recent Wednesday morning, taking hospital administrators by surprise.

Hospital inspections used to be anything but unexpected. Until 2000, even "random unannounced surveys" came with advance notice. Now hospitals have to be on their toes for 12 months, anticipating visits that come every three years.

"Typically they come on a Monday, so to show up on Wednesday, we were a little bit surprised," Dr. David Fairchild, the hospital's chief medical officer, said in a telephone interview. "Their mantra is, 'We can come any time.' Our strategy is to be ready no matter what day they come. They could come back next week."

More than the timing and secrecy of the inspections has changed, Fairchild said. "It used to be, you knew they were coming, so you would save up things and do them at the last minute," he said. "It used to be cramming for the test."

Before he came to Tufts, he said, he saw hospitals move copiers and stretchers out of hallways for the Joint Commission visit, and then move the equipment right back when the inspectors were gone. Widespread criticism halted the advance-notice policy in 2006.

"You basically pass the test, but don't improve the safety of your hospital in the long run" under the old model, he said. "I do think the Joint Commission has done a good thing by making hospitals think about changing the way they do business every day."

Among other methods, surveyors measure hospital performance by tracing a patient's path through the hospital, say from the emergency room to the operating room to the intensive care unit. Surveyors check to see whether doctors and nurses have washed their hands or taken time-outs to be certain the right thing is being done for the right patient, Fairchild said. Charts are reviewed to be sure the medications are correct. Sometimes surveyors look only at patient records, other times they come to the bedside. That's a change from past inspections that emphasized hospital policies and processes over how care was delivered.

"I give [the commission] credit for focusing more on national safety goals and things that are more relevant to improving the quality of care," he said.

Earlier this year, Beth Israel Deaconess Medical Center linked its online patient portal to Google Health, allowing patients and doctors to exchange information not only within the Beth Israel Deaconess clinical system, but also outside it.

Now Microsoft's HealthVault has joined the secure data-exchange party. Both options let patients upload information about their diagnoses, medications, and allergies, for example, onto their HealthVault or Google Health accounts to share with healthcare providers who don't have access to the hospital's PatientSite.

About 40,000 Beth Israel Deaconess patients and 1,000 clinicians use PatientSite to gain access to medical records, e-mail doctors, make appointments, renew prescriptions, and request referrals. Now patients can manage their health information from other sources through their choice of plan.

"We believe that patients should be the stewards of their own data," Dr. John Halamka, chief information officer at Beth Israel Deaconess, said in a statement. He is also part of the Google Health Advisory Council.