Comparison of Opioids Prescribed by Advanced Practice Clinicians vs Surgeons After Surgical Procedures in the US.
Comparison of Opioids Prescribed by Advanced Practice Clinicians vs Surgeons After Surgical Procedures in the US.
复制标题
DOI：
10.1001/jamanetworkopen.2022.49378
复制
发表时间：
2023-01-03
影响因子：
13.8
通讯作者：
Chua, Kao-Ping
中科院分区：
文献类型：
--
作者：
Priest, Caitlin R.;Waljee, Jennifer F.;Bicket, Mark C.;Hu, Hsou-Mei;Chua, Kao-Ping
这项横断面研究评估了临床医生类型和外科专业的术后阿片类药物处方实践和剂量。外科手术的阿片类药物处方中有多大比例是由高级实践临床医生（APC）撰写的？在这项涉及581387名成人和儿童的628197例外科手术的国家索赔数据的横断面研究中，五分之一的围手术期阿片类药物处方和四分之一的补充处方由APC撰写。APC撰写的围手术期阿片类药物处方的总剂量高于外科医生撰写的处方。这项研究的结果表明，阿片类药物管理举措，支持APC在手术阿片类药物处方的作用可能是必要的。高级实践临床医生（APC），被定义为执业护士和医生助理，越来越多地被纳入手术团队。尽管纳入了这一内容，但最近没有关于这些临床医生在手术阿片类药物处方或此类处方剂量中的作用的国家数据。计算APC开具的手术阿片类药物处方的比例，并将这些处方的总剂量和每日剂量与外科医生开具的处方进行比较。这项横断面研究使用了Optum的De-Identified Clinformatics Data Mart，其中包含来自美国各地拥有私人保险和Medicare Advantage计划的患者的去识别索赔。确定了从2017年1月1日至2019年11月30日接受31例住院和门诊手术中的1例的成人和儿童。该分析仅限于具有1个或多个围手术期阿片类药物处方的手术，定义为手术索引日期后3天内分发的阿片类药物处方。数据分析时间为2021年4月1日至2022年7月31日。开处方的专业。结果是围手术期阿片类药物处方和APC开具的补充处方的比例。使用线性回归来比较APC与外科医生以吗啡毫克当量（MME）测量的围手术期阿片类药物处方的总剂量。根据人口统计学特征、合并症、阿片类药物初治状态、索引日期年份、住院或观察状态、手术并发症和外科医生专业调整模型。在手术水平进行分析，并纳入了多次手术的患者。分析包括581387例患者的628197例手术（358541例女性[57.1%];平均[SD]年龄，56 [18]岁）。总体而言，APC在628197张围手术期阿片类药物处方中开具了119266张（19.0%），在237740张补充处方中开具了59679张（25.1%）。APC开具的围手术期阿片类药物处方的总剂量高于外科医生开具的处方（校正差异，40.0 MME; 95% CI，31.3-48.7 MME）。这种差异在仅限于阿片类药物初治患者的亚组分析中持续存在（校正差异，15.7 MME; 95% CI，13.9-17.5 MME）。在这项横断面分析中，五分之一的围手术期阿片类药物处方和四分之一的补充处方由APC撰写。虽然外科医生撰写了大多数用于围手术期镇痛的围手术期阿片类药物处方，但APC的总剂量较高，表明支持APC作用的阿片类药物管理计划可能是必要的。
This cross-sectional study assesses postsurgical opioid prescribing practice and dosing by clinician type and surgical specialty. What proportion of opioid prescriptions for surgical procedures is written by advanced practice clinicians (APCs)? In this cross-sectional study of national claims data for 628 197 surgical procedures involving 581 387 adults and children, one-fifth of perioperative opioid prescriptions and one-quarter of refill prescriptions were written by APCs. Perioperative opioid prescriptions written by APCs had higher total dosages compared with those written by surgeons. Findings of this study suggest that opioid stewardship initiatives that support the role of APCs in surgical opioid prescribing may be warranted. Advanced practice clinicians (APCs), defined as nurse practitioners and physician assistants, are increasingly being incorporated into surgical teams. Despite this inclusion, there are no recent national data on the role of these clinicians in surgical opioid prescribing or the dosing of such prescriptions. To calculate the proportion of surgical opioid prescriptions written by APCs and to compare the total and daily dosages of these prescriptions with those written by surgeons. This cross-sectional study used the Optum’s De-Identified Clinformatics Data Mart, which contains deidentified claims from patients with private insurance and Medicare Advantage plans across the US. Adults and children who underwent 1 of 31 inpatient and outpatient surgical procedures from January 1, 2017, through November 30, 2019, were identified. The analysis was limited to procedures with 1 or more perioperative opioid prescriptions, defined as an opioid prescription dispensed within 3 days of the index date of surgery. Data were analyzed from April 1, 2021, to July 31, 2022. Prescriber specialty. The outcome was the proportion of perioperative opioid prescriptions and refill prescriptions written by APCs. Linear regression was used to compare the total dosage of perioperative opioid prescriptions written by APCs vs surgeons measured in morphine milligram equivalents (MMEs). Models were adjusted for demographic characteristics, comorbidities, opioid-naive status, year of index date, hospitalization or observation status, surgical complications, and surgeon specialty. Analyses were conducted at the procedure level, and patients with multiple procedures were included. Analyses included 628 197 procedures for 581 387 patients (358 541 females [57.1%]; mean [SD] age, 56 [18] years). Overall, APCs wrote 119 266 (19.0%) of the 628 197 perioperative opioid prescriptions and 59 679 (25.1%) of the 237 740 refill prescriptions. Perioperative opioid prescriptions written by APCs had higher total dosages compared with those written by surgeons (adjusted difference, 40.0 MMEs; 95% CI, 31.3-48.7 MMEs). This difference persisted in a subgroup analysis limited to opioid-naïve patients (adjusted difference, 15.7 MMEs; 95% CI, 13.9-17.5 MMEs). In this cross-sectional analysis, one-fifth of perioperative opioid prescriptions and one-quarter of refill prescriptions were written by APCs. While surgeons wrote most perioperative opioid prescriptions that were intended for perioperative analgesia, higher total dosages from APCs suggest that opioid stewardship initiatives that support the role of APCs may be warranted.
登录
查看更多内容
影响因子：
3.4
作者：
Axeen, Sarah
通讯作者：
Axeen, Sarah
影响因子：
--
作者：
Iobst, Christopher A;Singh, Satbir;Yang, Jingzhen Z
通讯作者：
Yang, Jingzhen Z
影响因子：
3.8
作者：
Broman, Kristy K.;Baez, Hansel;Pimiento, Jose M.
通讯作者：
Pimiento, Jose M.
初始处方长度和处方限制对长时间术后阿片类药物使用的风险的影响。
影响因子：
3
作者：
Young JC;Dasgupta N;Chidgey BA;Stürmer T;Pate V;Hudgens M;Jonsson Funk M
通讯作者：
Jonsson Funk M
影响因子：
9
作者：
Larach DB;Waljee JF;Hu HM;Lee JS;Nalliah R;Englesbe MJ;Brummett CM
通讯作者：
Brummett CM