Variation in opioid analgesia administration and discharge prescribing for emergency department patients with suspected urolithiasis.
Variation in opioid analgesia administration and discharge prescribing for emergency department patients with suspected urolithiasis.
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DOI：
10.1016/j.ajem.2020.07.016
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Merchant RC
中科院分区：
文献类型：
--
作者：
Wentz AE;Wang RRC;Marshall BDL;Shireman TI;Liu T;Merchant RC
先前的研究建议在急诊科（ED）使用阿片类镇痛药时要谨慎，并提出了对处方阿片类镇痛药使用变化的担忧，无论是在不同的机构还是在不同的处方中。我们调查了15家参与研究的医院中疑似尿石症的急诊科患者使用阿片类镇痛药的情况。这是一项临床试验的二次分析，包括疑似尿石症的成人ED患者。在考虑医院聚类的多层次模型中，我们评估了与急诊科就诊期间阿片类镇痛药物给药和出院时处方相关的人口统计学、临床、州一级和医院一级因素。在2352名参与者中，67%的人在急诊科就诊时接受了阿片类镇痛药，61%的人在出院时服用了阿片类镇痛药。各医院阿片类镇痛药的使用差异很大，从46%到88%（就诊期间）和34%到85%（出院时）不等。西班牙裔患者在急诊科就诊期间接受阿片类镇痛药的可能性低于非西班牙裔白人患者（OR 0.72, 95% CI 0.55-0.94）。受过高等教育（OR 1.29, 95% CI 1.05-1.59）、有健康保险（OR 1.27, 95% CI 1.02-1.60）或在有处方药监测项目的州接受护理（OR 1.64, 95% CI 1.06-2.53）的患者更有可能在急诊科出院时接受阿片类镇痛药处方。我们发现阿片类镇痛药的给药和处方在医院水平上存在显著差异，并且与教育、医疗保险和种族/民族群体有关。这些数据可能会迫使临床医生和医院检查他们的阿片类药物使用实践，以确保其与公认的医疗实践一致。
Previous research has suggested caution about opioid analgesic usage in the emergency department (ED) setting and raised concerns about variations in prescription opioid analgesic usage, both across institutions and for whom they are prescribed. We examined opioid analgesic usage in ED patients with suspected urolithiasis across fifteen participating hospitals. This secondary analysis of a clinical trial including adult ED patients with suspected urolithiasis. In multilevel models accounting for clustering by hospital, we assessed demographic, clinical, state-level, and hospital-level factors associated with opioid analgesic administration during the ED visit and prescription at discharge. Of 2,352 participants, 67% received an opioid analgesic during the ED visit and 61% were prescribed one at discharge. Opioid analgesic usage varied greatly across hospitals, ranging from 46% to 88% (during visit) and 34% to 85% (at discharge). Hispanic patients were less likely than non-Hispanic white patients to receive opioid analgesics during the ED visit (OR 0.72, 95% CI 0.55–0.94). Patients with higher education (OR 1.29, 95% CI 1.05–1.59), health insurance coverage (OR 1.27, 95% CI 1.02–1.60), or receiving care in states with a prescription drug monitoring program (OR 1.64, 95% CI 1.06–2.53) were more likely to receive an opioid analgesic prescription at ED discharge. We found marked hospital-level differences in opioid analgesic administration and prescribing, as well as associations with education, healthcare insurance, and race/ethnicity groups. These data might compel clinicians and hospitals to examine their opioid use practices to ensure it is congruent with accepted medical practice.
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