Prevalence of psychotropic and opioid prescribing among hospice beneficiaries in the United States, 2014-2016.
Prevalence of psychotropic and opioid prescribing among hospice beneficiaries in the United States, 2014-2016.
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DOI：
10.1111/jgs.17085
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发表时间：
2021-06
影响因子：
6.3
通讯作者：
Maust DT
中科院分区：
文献类型：
--
作者：
Gerlach LB;Kales HC;Kim HM;Zhang L;Strominger J;Covinsky K;Teno J;Bynum JPW;Maust DT
在临终关怀中，精神类药物和阿片类药物通常用于症状管理，但全国性的用药情况估计数据缺失。2014年医疗保险临终关怀支付的变化为研究临终关怀受益人中精神类药物和阿片类药物的处方情况以及与特定药物类别使用相关的因素提供了首次机会。
对2014 - 2016年参加临终关怀且加入D部分的传统医疗保险和管理式医疗保险20%样本的横断面分析。
参加医疗保险临终关怀福利的受益人。
2014年7月1日至2016年12月31日期间新参加临终关怀的65岁及以上医疗保险受益人（N = 554,022）。
按类别划分的精神类药物和阿片类药物处方的流行率以及与处方相关的因素。
70.3%的临终关怀受益人被开具了精神类药物处方，63.3%被开具了阿片类药物处方。开具的最常见精神类药物类别为：苯二氮䓬类（60.6%）、抗精神病药（38.3%）、抗抑郁药（18.4%）和抗癫痫药（10.2%）。劳拉西泮（56.4%）、吗啡（52.8%）和氟哌啶醇（28.6%）是使用人数最多的药物。任何精神类药物和阿片类药物处方的流行率在女性（76.7%）、非西班牙裔白人（76.6%）以及癌症患者（78.9%）中最高。与白人受益人相比，非西班牙裔黑人受益人几乎不太可能使用每一类药物，使用阿片类药物（64.1%对57.9%；调整优势比0.75，95%置信区间0.72 - 0.77）和苯二氮䓬类药物（61.6%对52.2%；调整优势比0.66，95%置信区间0.64 - 0.68）的几率显著更低。在不同的临终关怀诊断中存在差异；癌症患者更有可能使用阿片类药物、苯二氮䓬类药物和抗精神病药，但不太可能使用抗抑郁药和抗癫痫药。
精神类药物和阿片类药物在临终关怀中经常被开具。观察到的不同种族和族裔之间处方的差异可能反映了处方差异以及患者对护理的偏好。鉴于围绕临终关怀中药物处方的研究有限，进一步的研究对于了解驱动处方的因素非常重要。
Psychotropic and opioid medications are routinely prescribed for symptom management in hospice, but national estimates of prescribing are lacking. Changes in Medicare hospice payment in 2014 provide the first opportunity to examine psychotropic and opioid prescribing among hospice beneficiaries, and the factors associated with use of specific medication classes. Cross-sectional analysis of a 20% sample of traditional and managed Medicare with Part D enrolled in hospice, 2014–2016. Beneficiaries enrolled in the Medicare hospice benefit. Medicare beneficiaries ≥65 newly enrolled in hospice between July 1, 2014 and December 31, 2016 (N = 554,022). Prevalence of psychotropic and opioid medication prescribing by class and factors associated with prescribing. 70.3% of hospice beneficiaries were prescribed a psychotropic and 63.3% were prescribed an opioid. The most common psychotropic classes prescribed were: benzodiazepines (60.6%), antipsychotics (38.3%), antidepressants (18.4%), and antiepileptics (10.2%). Lorazepam (56.4%), morphine (52.8%), and haloperidol (28.6%) were received by the most beneficiaries. Prevalence of any psychotropic and opioid prescription was highest among beneficiaries who were female (76.7%), non-Hispanic white (76.6%), and those with cancer (78.9%). Compared to white beneficiaries, non-Hispanic black beneficiaries were less likely to receive nearly every class of medication, with significantly lower odds of receiving opioids (64.1% vs 57.9%; AOR 0.75, 95% CI 0.72–0.77) and benzodiazepines (61.6% vs 52.2%; AOR 0.66, 95% CI 0.64–0.68). Differences were seen across hospice diagnosis; those with cancer were more likely to receive opioids, benzodiazepines, and antipsychotics but less likely to receive antidepressants and antiepileptics. Psychotropic and opioid medications are frequently prescribed in hospice. Observed variations in prescribing across race and ethnicity may reflect disparities in prescribing as well as patient preferences for care. Further work is important to understand factors driving prescribing given limited studies surrounding medication prescribing in hospice.
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DOI：
10.1177/1049909113476132
发表时间：
2014-03-01
影响因子：
1.9
作者：
Sera, Leah;McPherson, Mary Lynn;Holmes, Holly M.
通讯作者：
Holmes, Holly M.
影响因子：
6.3
作者：
Radcliff, Sue;Yue, Jirong;Beers, Mark H.
通讯作者：
Beers, Mark H.
影响因子：
5.7
作者：
Gerlach, Lauren B.;Strominger, Julie;Maust, Donovan T.
通讯作者：
Maust, Donovan T.
影响因子：
4.7
作者：
Kwon, Jung Hye;Kim, Min Ji;Hui, David
通讯作者：
Hui, David
DOI：
10.1001/jama.2017.11468
发表时间：
2017-09-19
期刊：
JAMA
影响因子：
--
作者：
Hui D;Frisbee-Hume S;Wilson A;Dibaj SS;Nguyen T;De La Cruz M;Walker P;Zhukovsky DS;Delgado-Guay M;Vidal M;Epner D;Reddy A;Tanco K;Williams J;Hall S;Liu D;Hess K;Amin S;Breitbart W;Bruera E
通讯作者：
Bruera E