Factors Associated With Persistent Opioid Use Among Injured Workers' Compensation Claimants
Factors Associated With Persistent Opioid Use Among Injured Workers' Compensation Claimants
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DOI：
10.1001/jamanetworkopen.2018.4050
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发表时间：
2018-10-01
影响因子：
13.8
通讯作者：
Slobogean, Gerard P.
中科院分区：
文献类型：
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作者：
O'Hara, Nathan N.;Pollak, Andrew N.;Slobogean, Gerard P.
重要性在工人索赔中缺乏关于持续使用阿片类药物和与持续使用阿片类药物相关的因素的数据。目的确定受伤工人在受伤后90天以上开出阿片类药物处方的比例以及与持续使用阿片类药物相关的因素。设计、设置、参与者这项回溯性队列研究收集了马里兰州切萨皮克雇主保险公司2008年1月1日至2016年12月31日期间的工人索赔数据。所有在研究期间受伤并且至少有1张阿片类药物处方的工人赔偿金申索人都有资格纳入。对于在多年的研究中有独特伤害索赔的患者，我们的分析中只包括第一个索赔的伤害。因声称受伤而死亡的患者被排除在外。这项分析是在2017年10月至2018年8月期间进行的。主要结果和衡量标准是持续使用阿片类药物，定义为自受伤之日起90天以上履行阿片类药物处方。结果9596名研究参与者(平均年龄[SD])被用来确定持续使用阿片类药物的预后因素。43[12.3]岁；6218[65.1%]男性)，2741(28.6%)自受伤之日起90天以上服用阿片类药物。年龄在60岁或以上的参与者(优势比[OR]，1.92；95%CI，1.56-2.36)、挤压伤(OR.1.55；95%可信区间1.28-1.89)。拉伤和扭伤(或1.54；95%可信区间为1.36~1.75)。年收入超过6万美元(OR，1.31；95%CI，1.07-1.61)和伴随慢性关节疼痛的诊断(OR，1.98；95%CI，1.79-2.20)与持续使用阿片类药物显著相关。与索赔被指定为永久部分残疾的工人相比，仅有医疗索赔的工人在受伤后90天持续使用阿片类药物的可能性显著降低(OR。0.17；95%CI，0.15-0.20)。结论和相关性在这一工人补偿队列中，持续使用阿片类药物的比例很高。减少这一人群中持续阿片类药物使用的干预措施应该针对具有本研究确定的特征的患者。
IMPORTANCE There is a paucity of data on persistent opioid use and factors associated with persistent opioid use among workers' compensation claimants.OBJECTIVE To determine the proportion of injured workers who filled an opioid prescription beyond 90 days from injury and the factors associated with persistent opioid use among workers' compensation claimants.DESIGN, SETTING, PARTICIPANTS This retrospective cohort study collected workers' compensation claims data from January 1, 2008, to December 31, 2016, from the Chesapeake Employers' Insurance Company in Maryland. All workers' compensation claimants injured during the study years and with at least 1 filled opioid prescription were eligible for inclusion. For patients who had unique injury claims in multiple years of the study, only the first claimed injury was included in our analysis. Patients who died as a result of the claimed injury were excluded. The analysis was performed between October 2017 and August 2018.MAIN OUTCOMES AND MEASURES The primary outcome was persistent opioid use, defined as an opioid prescription fulfillment beyond 90 days from the date of injury. Multivariable regression was used to determine prognostic factors of persistent opioid use.RESULTS Of the 9596 study participants (mean [SD] age. 43 [12.3] years; 6218 [65.1%] male), 2741 (28.6%) filled an opioid prescription more than 90 days from their date of injury. Participants aged 60 years or older (odds ratio [OR], 1.92; 95% CI, 1.56-2.36), crush injuries (OR. 1.55; 95% CI, 1.28-1.89). strain and sprain injuries (OR. 1.54; 95% CI, 1.36-1.75). annual income more than $60 000 (OR, 1.31; 95% CI, 1.07-1.61), and concomitant diagnoses for chronic joint pain (OR, 1.98; 95% CI, 1.79-2.20) were significantly associated with persistent opioid use. Compared with workers with claims designated as permanent partial disability, workers with medical-only claims were significantly less likely to have persistent opioid use at 90 days postinjury (OR. 0.17; 95% CI, 0.15-0.20).CONCLUSIONS AND RELEVANCE A high proportion of persistent opioid use was observed in this workers' compensation cohort. Interventions to lower persistent opioid use in this population should target patients with the characteristics identified in this study.