Patient, prescriber, and Community factors associated with filled naloxone prescriptions among patients receiving buprenorphine 2017-18.
Patient, prescriber, and Community factors associated with filled naloxone prescriptions among patients receiving buprenorphine 2017-18.
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DOI：
10.1016/j.drugalcdep.2021.108569
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发表时间：
2021-04-01
影响因子：
4.2
通讯作者：
Sorbero M
中科院分区：
文献类型：
--
作者：
Stein BD;Jones CM;Smart R;Sheng F;Sorbero M
向阿片类药物过量风险增加的患者开纳洛酮是阿片类药物过量预防工作的关键组成部分，但对于因阿片类药物使用障碍而接受丁丙诺啡的患者（此类高风险人群之一）中的纳洛酮填充情况知之甚少。这项回顾性横断面研究使用了去识别化的药房声明，这些声明占 50 个州和哥伦比亚特区零售药房开出的所有处方的 90%。我们进行了多变量逻辑回归来检查接受丁丙诺啡治疗的患者的纳洛酮处方，并评估了纳洛酮处方随患者、处方者和社区特征的变化。 4.5% 的丁丙诺啡治疗事件中发生了纳洛酮处方。通过医疗补助（aOR 2.40，95%CI 2.33 至 2.47）和医疗保险（aOR 1.53，95%CI 1.46 至 1.60）支付的发作比商业保险发作的配纳洛酮处方的几率更高。与主要处方者为成人初级保健医生的发作相比，由成瘾专家（aOR 1.30，95％CI 1.24至1.37）和医师助理/执业护士（aOR 1.57，95％CI 1.53至1.61）开出纳洛酮处方的几率更高。向接受丁丙诺啡的患者开纳洛酮代表了一种切实的临床行动，可以帮助预防阿片类药物过量死亡。然而，尽管建议向阿片类药物过量风险增加的患者联合开纳洛酮，但在配发丁丙诺啡的患者中，纳洛酮处方的配药率仍然很低。国家、保险公司和卫生系统应考虑实施战略，以促进增加向高危人群联合开具纳洛酮处方。
Prescribing naloxone to patients at increased opioid overdose risk is a key component of opioid overdose prevention efforts, but little is known about naloxone fills among patients receiving buprenorphine for opioid use disorder, one such high risk group. This retrospective cross-sectional study used de-identified pharmacy claims representing 90% of all prescriptions filled at retail pharmacies in 50 states and the District of Columbia. We performed a multivariable logistic regression to examine filled naloxone prescriptions among patients receiving buprenorphine treatment and assessed how filled naloxone prescriptions vary by patient, prescriber, and community characteristics. Filled naloxone prescriptions occurred among 4.5% of buprenorphine treatment episodes. Episodes paid through Medicaid (aOR 2.40, 95%CI 2.33 to 2.47) and Medicare (aOR 1.53, 95%CI 1.46 to 1.60) had higher odds of filled naloxone prescriptions than commercial insurance episodes. Compared to episodes where the primary prescriber was an adult primary care physician, odds of filling a naloxone prescription were higher among episodes prescribed by addiction specialists (aOR 1.30, 95% CI 1.24 to 1.37) and physician assistants/nurse practitioners (aOR 1.57, 95% CI 1.53 to 1.61). Prescribing naloxone to patients receiving buprenorphine represents a tangible clinical action that can be taken to help prevent opioid overdose deaths. However, despite recommendations to co-prescribe naloxone to patients at increased risk for opioid overdose, rates of filling naloxone prescriptions remain low among patients dispensed buprenorphine. States, insurers, and health systems should consider implementing strategies to facilitate increased co-prescribing of naloxone to at-risk individuals.
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