Predictors of higher-risk chronic opioid prescriptions in an academic primary care setting
Predictors of higher-risk chronic opioid prescriptions in an academic primary care setting
复制标题
DOI：
10.1080/08897077.2015.1129020
复制
发表时间：
2016-01-02
期刊：
影响因子：
3.5
通讯作者：
Steiger, Scott
中科院分区：
文献类型：
--
作者：
Bauer, Scott R.;Hitchner, Lily;Steiger, Scott
背景：接受大剂量阿片类药物或同时使用阿片类药物治疗的慢性非癌症疼痛患者发生不良事件的风险增加。尽管几个国家指南建议最大剂量阈值和尿药测试，但遵守这些指南并不一致。方法：为了在两个学术初级保健诊所确定高风险阿片类药物处方的预测因素，作者对2012年3月至2013年3月期间842名患者进行了回顾性队列研究，这些患者开出了5张阿片类药物处方，用于治疗非癌症疼痛。作者使用多变量Logistic模型评估了高剂量阿片类药物处方和尿药测试的几率。结果：在研究对象中，47%的人每天服用相当于50毫克吗啡的处方。在调整混杂因素后，与教师提供者相比，住院初级保健提供者的患者更不可能获得更高剂量的处方(优势比=0.66，95%可信区间：0.46-0.94)，而非本地家庭地址的患者更有可能获得更高剂量的处方(优势比=2.1，95%可信区间：1.5-2.9)。西班牙裔、亚洲人和老年患者也不太可能被开出更高剂量的处方。尿液药物检测没有定期完成(2年内有35%)，但自认为是黑人的患者、有常驻初级保健提供者、居住在当地或被开出更高剂量阿片类药物的患者接受测试的几率更高。结论：在这种学术临床环境中，住院初级保健提供者的患者不太可能接受风险更高的阿片类药物处方，西班牙裔、亚洲人和老年患者也是如此。黑人患者完成尿液药物测试的频率更高，与其他患者和提供者的特征无关。还需要进行更多的研究，以评估为什么前往初级保健诊所的距离较长的患者会被开出更高剂量的阿片类药物来治疗慢性非癌症疼痛。
Background: Patients with chronic noncancer pain treated with higher doses of opioids or concurrent substance use are at increased risk of adverse events. Although several national guidelines recommend maximum dosing thresholds and urine drug testing, adherence to these guidelines is inconsistent. Methods: To identify predictors of higher-risk opioid prescriptions in 2 academic primary care clinics, the authors developed a retrospective cohort of 842 patients who were prescribed >= 5 opioid prescriptions for noncancer pain between March 2012 and March 2013. The authors evaluated odds of higher-dose opioid prescriptions and urine drug testing using multivariate logistic models. Results: Among study subjects, 47% received prescriptions for the equivalent of >= 50mg morphine per day. After adjustment for confounders, patients with a resident primary care provider were less likely to receive higher-dose prescriptions compared with faculty providers (odds ratio = 0.66, 95% confidence interval [CI]: 0.46-0.94), whereas patients with a nonlocal home address were more likely to be prescribed higher doses (odds ratio = 2.1, 95% CI: 1.5-2.9). Hispanic, Asian, and older patients were also less likely to be prescribed higher doses. Urine drug testing was not regularly completed (35% over 2years), but odds of testing were higher for patients who self-identified as black, had resident primary care providers, lived locally, or were prescribed higher opioid doses. Conclusions: In this academic clinical setting, patients with a resident primary care provider are less likely to receive higher-risk opioid prescriptions, as are Hispanic, Asian, and older patients. Black patients complete urine drug tests more frequently independent of other patient and provider characteristics. Additional studies are needed to assess why patients who travel larger distances to their primary care clinic are prescribed higher doses of opioids for chronic noncancer pain.