Changes in Surgical Opioid Prescribing and Patient-Reported Outcomes After Implementation of an Insurer Opioid Prescribing Limit.
Changes in Surgical Opioid Prescribing and Patient-Reported Outcomes After Implementation of an Insurer Opioid Prescribing Limit.
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DOI：
10.1001/jamahealthforum.2023.3541
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发表时间：
2023-10-06
期刊：
影响因子：
--
通讯作者：
Waljee, Jennifer F.
中科院分区：
文献类型：
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作者：
Chua, Kao-Ping;Nguyen, Thuy D.;Brummett, Chad M.;Bohnert, Amy S.;Gunaseelan, Vidhya;Englesbe, Michael J.;Waljee, Jennifer F.
商业保险公司5天阿片类药物处方限制的实施是否与接受手术的成年患者中患者报告的结果（如疼痛控制）的变化相关？在这项与密歇根州处方药监测计划数据库相关的全州手术登记的横断面分析中，限制实施与阿片类药物处方和配药的适度减少有关，但与接受普通普通外科手术的6045名成年人中患者报告的结局恶化无关。研究结果表明，保险公司的限制与手术后患者报告的结果恶化无关，但需要进行额外的研究以确定研究结果是否适用于其他阿片类药物处方限制和手术程序。保险公司越来越多地限制阿片类药物治疗急性疼痛的持续时间。在接受手术的患者中，目前尚不清楚这些限制的实施是否与阿片类药物处方和患者报告的结局（如疼痛）的变化相关。评估密歇根州一家大型商业保险公司实施阿片类药物处方限制后，手术阿片类药物处方和患者报告结局的变化。这是一项具有中断时间序列分析的横断面研究。数据分析于2022年10月1日至2023年2月28日进行。主要数据来源是密歇根州外科质量合作组织，这是一个全州范围内的登记处，包含接受普通普通外科手术的成人阿片类药物处方和患者报告的结果数据。该登记处与密歇根州的处方药监测计划数据库相链接，允许观察阿片类药物的分配。该研究包括6045名由商业保险公司承保的成年人，他们在2017年1月1日至2019年10月31日期间接受了手术。2018年2月将阿片类药物处方限制在5天供应量的政策。在所有患者中，使用分段回归模型评估2018年2月期间3个患者报告结局的水平或斜率变化：术后一周的疼痛（按1-4级评定：1 =无，2 =极轻微，3 =中度，4 =重度），手术经验满意度（0-10分，10分为最高满意度）和对接受手术的后悔程度（1-5分，1分为最高后悔程度）。在出院阿片类药物处方和分发阿片类药物处方（出院后3天内填写处方）的患者中，其他结局包括这些处方中的总吗啡毫克当量，阿片类药物体积的标准化测量。在纳入研究的6045例患者中，平均（SD）年龄为48.7（12.6）岁，3595例（59.5%）为女性。实施限制与患者报告的满意度或遗憾的变化无关，仅与患者报告的疼痛评分轻微降低相关（-0.15 [95% CI，-0.26至-0.03]）。在4396例（72.7%）出院和分发阿片类药物处方的患者中，限制实施分别与出院和分发阿片类药物处方的月平均总吗啡毫克当量减少−22.3（95% CI，−32.8至−11.9）和−26.1（95% CI，−40.9至−11.3）水平相关。这些减少大约相当于3 - 3.5片含5 mg羟考酮的药丸。这项对接受普通外科手术的成年人数据的横断面分析发现，实施保险公司的限制与阿片类药物处方的适度减少有关，但与患者报告的结果恶化无关。这些发现是否适用于其他程序值得进一步研究。这项横断面研究确定了在实施商业保险公司的5天阿片类药物处方限制后，患者报告的结果（如疼痛控制）是否发生了变化。
Is implementation of a commercial insurer’s 5-day opioid prescribing limit associated with a change in patient-reported outcomes, such as pain control, among adult patients undergoing surgery? In this cross-sectional analysis of a statewide surgical registry linked to the Michigan prescription drug monitoring program database, limit implementation was associated with modest reductions in opioid prescribing and dispensing but not with worsened patient-reported outcomes among 6045 adults undergoing common general surgical procedures. Findings suggest that the insurer’s limit was not associated with worsened patient-reported outcomes after surgery, but additional studies are needed to determine whether findings generalize to other opioid prescribing limits and surgical procedures. Insurers are increasingly limiting the duration of opioid prescriptions for acute pain. Among patients undergoing surgery, it is unclear whether implementation of these limits is associated with changes in opioid prescribing and patient-reported outcomes, such as pain. To assess changes in surgical opioid prescribing and patient-reported outcomes after implementation of an opioid prescribing limit by a large commercial insurer in Michigan. This was a cross-sectional study with an interrupted time series analysis. Data analyses were conducted from October 1, 2022, to February 28, 2023. The primary data source was the Michigan Surgical Quality Collaborative, a statewide registry containing data on opioid prescribing and patient-reported outcomes from adults undergoing common general surgical procedures. This registry is linked to Michigan’s prescription drug monitoring program database, allowing observation of opioid dispensing. The study included 6045 adults who were covered by the commercial insurer and underwent surgery from January 1, 2017, to October 31, 2019. Policy limiting opioid prescriptions to a 5-day supply in February 2018. Among all patients, segmented regression models were used to assess for level or slope changes during February 2018 in 3 patient-reported outcomes: pain in the week after surgery (assessed on a scale of 1-4: 1 = none, 2 = minimal, 3 = moderate, and 4 = severe), satisfaction with surgical experience (scale of 0-10, with 10 being the highest satisfaction), and amount of regret regarding undergoing surgery (scale of 1-5, with 1 being the highest level of regret). Among patients with a discharge opioid prescription and a dispensed opioid prescription (prescription filled within 3 days of discharge), additional outcomes included total morphine milligram equivalents in these prescriptions, a standardized measure of opioid volume. Among the 6045 patients included in the study, mean (SD) age was 48.7 (12.6) years and 3595 (59.5%) were female. Limit implementation was not associated with changes in patient-reported satisfaction or regret and was associated with only a slight level decrease in patient-reported pain score (−0.15 [95% CI, −0.26 to −0.03]). Among 4396 patients (72.7%) with a discharge and dispensed opioid prescription, limit implementation was associated with a −22.3 (95% CI, −32.8 to −11.9) and −26.1 (95% CI, −40.9 to −11.3) level decrease in monthly mean total morphine milligram equivalents of discharge and dispensed opioid prescriptions, respectively. These decreases corresponded approximately to 3 to 3.5 pills containing 5 mg of oxycodone. This cross-sectional analysis of data from adults undergoing general surgical procedures found that implementation of an insurer’s limit was associated with modest reductions in opioid prescribing but not with worsened patient-reported outcomes. Whether these findings generalize to other procedures warrants further study. This cross-sectional study determines whether patient-reported outcomes, such as pain control, changed after implementation of a commercial insurer’s 5-day opioid prescribing limit.
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影响因子：
4.2
作者：
Maierhofer, Courtney N.;Ranapurwala, Shabbar I.;Pence, Brian W.
通讯作者：
Pence, Brian W.
影响因子：
33.7
作者：
Dowell, Deborah;Ragan, Kathleen R;Jones, Christopher M;Baldwin, Grant T;Chou, Roger
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影响因子：
6
作者：
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通讯作者：
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DOI：
10.1046/j.1365-2710.2002.00430.x
发表时间：
2002-08-01
影响因子：
2
作者：
Wagner, AK;Soumerai, SB;Ross-Degnan, D
通讯作者：
Ross-Degnan, D
影响因子：
16.9
作者：
Harbaugh, Calista M.;Lee, Jay S.;Waljee, Jennifer F.
通讯作者：
Waljee, Jennifer F.