Inappropriate opioid prescribing among hospital inpatients before palliative care referral: prevalence and predictors – retrospective study

OBJECTIVES: This study aimed to examine the prevalence and appropriateness of opioid prescribing among hospital inpatients prior to palliative care consultation, and to identify clinical and demographic factors associated with appropriate prescribing practices in a tertiary hospital setting. METHODS: This retrospective cross-sectional study at Thammasat University Hospital, Thailand, from August 2021 to July 2022, assessed opioid prescribing patterns among inpatients aged 18 or older referred to the palliative care team. Data on demographics, clinical features and prescriptions were extracted from electronic records, and appropriateness was evaluated based on institutional guidelines. Multivariate logistic regression identified factors associated with regular opioid use. RESULTS: Among 329 patients, only 21.3% received regular opioids before consultation, with appropriate use in just 9.4%. Among those receiving regular opioids, only 18.6% were prescribed a breakthrough medication. Inappropriateness was largely due to omissions. Age >70 years (adjusted OR (aOR) 0.48, 95% CI 0.26 to 0.87) and higher Palliative Performance Scale (>20) (aOR 0.32, 95% CI 0.16 to 0.63) were significantly associated with lower odds of regular opioid use. CONCLUSION: Inappropriate opioid prescribing was prevalent among inpatients before palliative care consultation. Findings highlight the need for targeted education and systematic protocols to improve opioid use in hospital settings where specialist palliative input may be delayed.