Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use
Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use
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DOI：
10.1016/j.annemergmed.2017.08.042
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发表时间：
2018-03-01
影响因子：
6.2
通讯作者：
Bellolio, M. Fernanda
中科院分区：
文献类型：
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作者：
Jeffery, Molly Moore;Hooten, W. Michael;Bellolio, M. Fernanda
研究目的：我们通过比较急诊科处方与其他环境处方的指南一致性以及患者持续长期使用阿片类药物的风险，探讨急诊科 (ED) 对未使用阿片类药物的患者处方阿片类药物的贡献。方法：我们使用了未使用阿片类药物的私人受保人和 Medicare Advantage（老年人和残疾人）的行政索赔数据（OptumLabs 数据仓库 2009 年至 2015 年）分析受益人将急诊室开出的阿片类药物处方的特征与其他机构开出的阿片类药物处方的特征进行比较。报告与疾病控制和预防中心 (CDC) 指南的一致性以及长期使用阿片类药物的进展率。结果：我们确定了 520 万份符合纳入标准的阿片类药物处方。与非急诊科的阿片类药物处方相比，急诊科的阿片类药物处方更有可能遵守 CDC 的剂量、供应天数和配方指南。残疾医疗保险受益人最有可能发展为长期使用，其 13.4% 的医疗保险受益人实现了长期使用，而老年医疗保险受益人的这一比例为 6.2%，商业受益人的这一比例为 1.8%。与非急诊室患者相比，商业受益人在急诊室接受阿片类药物处方的可能性降低 46%，老年医疗保险患者发展为长期使用阿片类药物的可能性降低 56%，残疾医疗保险患者发展为长期使用阿片类药物的可能性降低 58%。结论：与非急诊室环境相比，在急诊室向未使用过阿片类药物的患者提供的阿片类药物处方更有可能符合 CDC 的建议。它们较短，针对较低的每日剂量，不太可能用于长效制剂。急诊科的处方与长期使用进展的风险较低有关。
Study objective: We explore the emergency department (ED) contribution to prescription opioid use for opioid-naive patients by comparing the guideline concordance of ED prescriptions with those attributed to other settings and the risk of patients' continuing long-term opioid use.Methods: We used analysis of administrative claims data (OptumLabs Data Warehouse 2009 to 2015) of opioid-naive privately insured and Medicare Advantage (aged and disabled) beneficiaries to compare characteristics of opioid prescriptions attributed to the ED with those attributed to other settings. Concordance with Centers for Disease Control and Prevention (CDC) guidelines and rate of progression to long-term opioid use are reported.Results: We identified 5.2 million opioid prescription fills that met inclusion criteria. Opioid prescriptions from the ED were more likely to adhere to CDC guidelines for dose, days' supply, and formulation than those attributed to non-ED settings. Disabled Medicare beneficiaries were the most likely to progress to long-term use, with 13.4% of their fills resulting in long-term use compared with 6.2% of aged Medicare and 1.8% of commercial beneficiaries' fills. Compared with patients in non-ED settings, commercial beneficiaries receiving opioid prescriptions in the ED were 46% less likely, aged Medicare patients 56% less likely, and disabled Medicare patients 58% less likely to progress to long-term opioid use.Conclusion: Compared with non-ED settings, opioid prescriptions provided to opioid-naive patients in the ED were more likely to align with CDC recommendations. They were shorter, written for lower daily doses, and less likely to be for long-acting formulations. Prescriptions from the ED are associated with a lower risk of progression to long-term use.