High-Risk Prescribing to Medicaid Enrollees Receiving Opioid Analgesics: Individual- and County-Level Factors
High-Risk Prescribing to Medicaid Enrollees Receiving Opioid Analgesics: Individual- and County-Level Factors
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DOI：
10.1080/10826084.2017.1416407
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发表时间：
2018-01-01
影响因子：
2
通讯作者：
Stein, Bradley D.
中科院分区：
文献类型：
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作者：
Heins, Sara E.;Sorbero, Mark J.;Stein, Bradley D.
背景：近年来，处方阿片类药物过量大幅增加，其中医疗补助参与者的比例最高。高风险处方包括与过量有关的做法和一系列与阿片类药物有关的其他问题。目的：在接受阿片类药物的医疗补助参与者中，确定与高风险处方相关的个人和县级因素。方法：在一项包含四个州的横断面索赔数据研究中，确定了2007-2009年接受新阿片类止痛药治疗的18-64岁的医疗补助参与者。多因素回归分析确定与高风险处方相关的因素，定义为大剂量阿片类药物处方(吗啡相当于每日剂量100 mg，连续6天)、阿片类药物重叠、阿片类药物与苯二氮卓类药物重叠。结果：高风险处方发生率为39.4%。年龄较大、农村居住地、白人和重度抑郁症诊断与所有类型的高风险处方的比率较高相关。与没有阿片类药物、酒精和催眠/镇静使用障碍的人相比，有阿片类药物、酒精和催眠/镇静使用障碍的人开出大剂量阿片类药物的几率较低，但阿片类药物重叠和阿片-苯二氮卓类药物重叠的几率较高。在马萨诸塞州，大剂量阿片类药物的处方比加利福尼亚州、伊利诺伊州和纽约州要少，而苯二氮卓类药物的重叠率在马萨诸塞州比其他州更常见。结论/重要性：高风险处方很常见，并与几个重要的人口统计学、临床和社区因素有关。研究结果可用于为旨在减少此类处方的有针对性的干预措施提供信息，鉴于观察到的州差异，需要进一步研究，以更好地了解国家政策对高风险处方的影响。
Background: Prescription opioid overdoses have increased dramatically in recent years, with the highest rates among Medicaid enrollees. High-risk prescribing includes practices associated with overdoses and a range of additional opioid-related problems. Objectives: To identify individual- and county-level factors associated with high-risk prescribing among Medicaid enrollees receiving opioids. Methods: In a four-states, cross-sectional claims data study, Medicaid enrollees 18-64years old with a new opioid analgesic treatment episode 2007-2009 were identified. Multivariate regression analyses were conducted to identify factors associated with high-risk prescribing, defined as high-dose opioid prescribing (morphine equivalent daily dose 100mg for >6days), opioid overlap, opioid-benzodiazepine overlap. Results: High-risk prescribing occurred in 39.4% of episodes. Older age, rural county of residence, white race, and major depression diagnosis were associated with higher rates of all types of high-risk prescribing. Individuals with prior opioid, alcohol, and hypnotic/sedative use disorder diagnoses had lower odds of high-dose opioid prescribing but higher odds of opioid overlap and opioid-benzodiazepine overlap than individuals without such disorders. High-dose opioid prescribing in Massachusetts was less common than in California, Illinois, and New York, whereas the rate of benzodiazepine overlap in Massachusetts was more common than in other states. Conclusions/Importance: High-risk prescribing was common and associated with several important demographic, clinical, and community factors. Findings can be used to inform targeted interventions designed to reduce such prescribing, and given state variation observed, further research is needed to better understand the effects of state policies on high-risk prescribing.