Effect of a high dosage opioid prior authorization policy on prescription opioid use, misuse, and overdose outcomes.
Effect of a high dosage opioid prior authorization policy on prescription opioid use, misuse, and overdose outcomes.
复制标题
DOI：
10.1080/08897077.2017.1389798
复制
发表时间：
2018
期刊：
影响因子：
3.5
通讯作者：
McConnell, K. John
中科院分区：
文献类型：
--
作者：
Hartung, Daniel M.;Kim, Hyunjee;Ahmed, Sharia M.;Middleton, Luke;Keast, Shellie;Deyo, Richard A.;Zhang, Kun;McConnell, K. John
高剂量阿片类药物的使用是阿片类药物相关过量的危险因素，通常在指南、建议和政策中被引用。2012年，俄勒冈州医疗补助计划为每天超过120毫克吗啡当量(MED)的阿片类药物处方制定了一项事先授权政策。这项研究旨在评估该政策对使用率、处方模式和健康结果的影响。利用2011年至2013年俄勒冈州和一个控制州(科罗拉多州)的行政索赔数据，使用差异分析来检查政策出台后使用情况的变化、高风险阿片类药物使用的措施以及过量使用。还对政策前大剂量阿片类药物使用者的阿片类药物使用情况进行了评估。在俄勒冈州的大剂量政策实施后，每月阿片类药物填充超过120 mg MED的概率显著下降了1.7个百分点(95%可信区间[CI]；−2.0%至−1.4%)，而阿片类药物填充61 mg MED的概率显著增加了1.0个百分点(95%CI 0.4%至1.7%)。用于治疗神经性疼痛的药物的填充率也增加了1.2个百分点(95%可信区间0.7%至1.8%)。在事先授权后，每月多次使用药物的可能性下降了0.1个百分点(−0.2%至−0.0)，但因阿片类药物过量而遇到ED或住院的情况没有显著变化。在政策实施前使用大剂量阿片类药物的个体中，政策实施后高剂量填充的估计概率下降了20.3个百分点(95%CI−为15.3%，−为25.3%)。俄勒冈州的事先授权政策在减少大剂量阿片类药物处方方面是有效的。虽然多次药物使用也有所下降，但没有观察到阿片类药物过量的变化。
High dosage opioid use is a risk factor for opioid-related overdose commonly cited in guidelines, recommendations, and policies. In 2012, the Oregon Medicaid program developed a prior authorization policy for opioid prescriptions above 120 mg per day morphine equivalent dose (MED). This study aimed to evaluate the effects of that policy on utilization, prescribing patterns, and health outcomes. Using administrative claims data from Oregon and a control state (Colorado) between 2011 and 2013, difference-in-differences analyses were used to examine changes in utilization, measures of high risk opioid use, and overdose after introduction of the policy. Opioid utilization in a cohort of individuals who were high dosage opioid users before the policy was also evaluated. Following implementation of Oregon’s high dosage policy, the monthly probability of an opioid fill over 120 mg MED declined significantly by 1.7 percentage points (95% confidence interval [CI]; −2.0% to −1.4%), whereas it increased significantly by 1.0 percentage points (95% CI 0.4% to 1.7%) for opioid fills < 61 mg MED. Fills of medications used to treat neuropathic pain also increased by 1.2 percentage points (95% CI 0.7% to 1.8%). The monthly probability of multiple pharmacy use declined by 0.1 percentage points (−0.2% to −0.0) following the prior authorization, but there were no significant changes in ED encounters or hospitalizations for opioid overdose. Among individuals who were using a high dosage opioid before the policy, there was a 20.3 percentage point (95% CI −15.3% to −25.3%) decline in estimated probability of having a high dosage fill after the policy. Oregon’s prior authorization policy was effective at reducing high dosage opioid prescriptions. While multiple pharmacy use also declined, no changes in opioid overdose were observed.
登录
查看更多内容
影响因子：
3.1
作者：
Paulozzi, Leonard J.;Kilbourne, Edwin M.;Loring, Larry D.
通讯作者：
Loring, Larry D.
影响因子：
3.1
作者：
Dasgupta, Nabarun;Funk, Michele Jonsson;Marshall, Steve
通讯作者：
Marshall, Steve
影响因子：
2.1
作者：
Garcia, Maria M.;Angelini, Michael C.;Jeffrey, Paul
通讯作者：
Jeffrey, Paul
影响因子：
3
作者：
Bohnert, Amy S. B.;Logan, Joseph E.;Dowell, Deborah
通讯作者：
Dowell, Deborah
影响因子：
39.2
作者：
Dunn, Kate M.;Saunders, Kathleen W.;Von Korff, Michael
通讯作者：
Von Korff, Michael