Opioid-related emergency department visits and hospitalizations among patients with chronic gastrointestinal symptoms and disorders dually enrolled in the Department of Veterans Affairs and Medicare Part D.
Opioid-related emergency department visits and hospitalizations among patients with chronic gastrointestinal symptoms and disorders dually enrolled in the Department of Veterans Affairs and Medicare Part D.
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退伍军人事务部和医疗保险 D 部分双重登记的患有慢性胃肠道症状和疾病的患者与阿片类药物相关的急诊就诊和住院情况。
DOI：
10.1093/ajhp/zxab363
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Lambert,BruceL
中科院分区：
文献类型：
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作者：
Balbale,SalvaN;Cao,Lishan;Trivedi,Itishree;Stulberg,JonahJ;Suda,KatieJ;Gellad,WalidF;Evans,CharlesnikaT;Jordan,Neil;Keefer,LaurieA;Lambert,BruceL
研究目的：我们在退伍军人事务部（VA）和医疗保险D部分双重登记的慢性胃肠道（GI）症状和疾病患者中，检查导致急诊（艾德）就诊或住院的严重阿片类药物相关不良药物事件（ORADE）的患病率及其相关因素。（2011年4月1日至2014年10月31日）从VA和医疗保险和医疗补助服务中心，以确定严重的口腔溃疡和腹泻的双重登记退伍军人与慢性胃肠道症状或疾病。结局指标包括严重ORADE，定义为因ORADE导致的艾德访视或因阿片类药物导致的主要或次要入院原因而住院。我们采用多元Logistic回归模型，以确定独立相关的因素与严重的ORADE.ResultsWe确定了3,430退伍军人谁有慢性胃肠道症状或疾病，双重参加了VA和医疗保险D部分，并有严重的ORADE，导致艾德访问，住院治疗，或两者兼而有之。总体而言，严重ORADE的阶段患病率为2.4%，慢性阿片类药物使用（≥90连续天）的退伍军人为4.4%。患有严重口腔溃疡性腹泻的退伍军人更可能是40岁以下、男性、白色、慢性腹痛、功能性胃肠道疾病、慢性胰腺炎或克罗恩病。他们也更有可能长期使用阿片类药物并以较高的日剂量使用。结论在患有慢性胃肠道症状和疾病的患者中，严重的口服药物可能会造成相当大的负担。未来的质量改进工作应针对这一弱势群体。
PurposeWe examined the prevalence of, and factors associated with, serious opioid-related adverse drug events (ORADEs) that led to an emergency department (ED) visit or hospitalization among patients with chronic gastrointestinal (GI) symptoms and disorders dually enrolled in the Department of Veterans Affairs (VA) and Medicare Part D.MethodsIn this retrospective cohort study, we used linked national patient-level data (April 1, 2011, to October 31, 2014) from the VA and Centers for Medicare and Medicaid Services to identify serious ORADEs among dually enrolled veterans with a chronic GI symptom or disorder. Outcome measures included serious ORADEs, defined as an ED visit attributed to an ORADE or a hospitalization where the principal or secondary reason for admission involved an opioid. We used multiple logistic regression models to determine factors independently associated with a serious ORADE.ResultsWe identified 3,430 veterans who had a chronic GI symptom or disorder; were dually enrolled in the VA and Medicare Part D; and had a serious ORADE that led to an ED visit, hospitalization, or both. The period prevalence of having a serious ORADE was 2.4% overall and 4.4% among veterans with chronic opioid use (≥90 consecutive days). Veterans with serious ORADEs were more likely to be less than 40 years old, male, white, and to have chronic abdominal pain, functional GI disorders, chronic pancreatitis, or Crohn’s disease. They were also more likely to have used opioids chronically and at higher daily doses.ConclusionThere may be a considerable burden of serious ORADEs among patients with chronic GI symptoms and disorders. Future quality improvement efforts should target this vulnerable population.