Compliance with Opioid Treatment Guidelines for Chronic Non-Cancer Pain (CNCP) in Primary Care at a Veterans Affairs Medical Center (VAMC)
Compliance with Opioid Treatment Guidelines for Chronic Non-Cancer Pain (CNCP) in Primary Care at a Veterans Affairs Medical Center (VAMC)
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DOI：
10.1111/pme.12164
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发表时间：
2013-10-01
期刊：
影响因子：
3.1
通讯作者：
Robinette, Camille
中科院分区：
文献类型：
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作者：
Sekhon, Ripple;Aminjavahery, Noushin;Robinette, Camille
本研究的主要目的是测量初级保健环境中慢性非癌症疼痛（CNCP）的退伍军人事务部/国防部治疗指南的处方依从性。我们还确定了表现出异常药物相关行为（ADRBs）的受试者比例以及与之相关的患者特征。设计这是一项回顾性图表回顾。设置退伍军人事务医疗中心的初级保健设置。受试者所有年龄在18岁至87岁之间的CNCP患者，在1年期间连续3个月或更长时间接受阿片类药物处方（2009年7月至2010年8月）符合入选条件。使用药房处方数据库随机抽取800例患者。卡方检验被用来分析ADRB和患者的characteristics.ResultsAbout一半的患者在我们的样本中有一个签署阿片类药物疼痛护理协议（OPCA），并获得至少一个尿液药物测试（UDT）之间的关联。UDT在19.5%的患者中对非法药物/未报告的阿片类药物呈阳性，在25.2%的样本中对处方药物呈阴性。约10%的样本人群的吗啡当量剂量等于或大于200 mg/天。在22.9%的患者中发现了ADRB。年轻的年龄，精神科合并症，药物滥用史，高阿片类药物剂量与ADRB的高风险，但OPCA的存在降低了ADRB.ConclusionThis的风险本文研究了阿片类药物的处方实践在初级保健环境，可用于提高供应商的教育慢性疼痛的指导方针。
ObjectiveThe primary objective of this study was to measure prescribing compliance with the Veterans Affairs/Department of Defense treatment guidelines for chronic non-cancer pain (CNCP) in the primary care setting. We also determined the proportion of subjects who demonstrated aberrant drug-related behaviors (ADRBs) and the patient characteristics associated with them.DesignThis is a retrospective chart review.SettingPrimary care setting in Veterans Affairs Medical Center.SubjectsAll patients with CNCP between the ages of 18 and 87 years who received opioid prescriptions for 3 or more consecutive months during a 1-year period (July 2009 to August 2010) were eligible for inclusion. A random sample of 800 patients was selected using pharmacy prescription database. Chi-square test was utilized to analyze associations between ADRB and patient characteristics.ResultsAbout half the patients in our sample had a signed opioid pain care agreement (OPCA), and at least one urine drug test (UDT) was obtained. UDT was positive for an illicit drug/unreported opioid in 19.5% of the patients, and negative for the prescribed drug in 25.2% of the sample. About 10% of the sample population had morphine equivalent dose equal to or greater than 200mg/day. ADRBs were identified in 22.9% of the patients. Younger age, psychiatric comorbidities, history of substance abuse, and high opioid dose were associated with high risk of ADRB, but the presence of OPCA lowered the risk of ADRB.ConclusionThis article studied the prescribing practices of opioids in a primary care setting and can be used to enhance provider education regarding chronic pain guidelines.