Effects of a prior authorization policy for extended-release/long-acting opioids on utilization and outcomes in a state Medicaid program.
Effects of a prior authorization policy for extended-release/long-acting opioids on utilization and outcomes in a state Medicaid program.
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DOI：
10.1111/add.14248
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发表时间：
2018-04-20
期刊：
影响因子：
6
通讯作者：
Hartung, Daniel M.
中科院分区：
文献类型：
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作者：
Keast, Shellie L.;Kim, Hyunjee;Deyo, Richard A.;Middleton, Luke;McConnell, K. John;Zhang, Kun;Ahmed, Sharia M.;Nesser, Nancy;Hartung, Daniel M.
为了应对阿片类药物过量的流行，美国州医疗补助计划对阿片类镇痛药采取了限制性政策，但对处方模式和健康结果的影响尚不确定。本研究旨在检查美国俄克拉荷马州州医疗补助计划中缓释/长效（ER/LA）阿片类药物的事先授权政策对阿片类药物使用的影响。比较俄克拉荷马州医疗补助与对照（俄勒冈州医疗补助）中阿片类药物使用变化的回顾性差异设计研究。美国俄克拉荷马州和俄勒冈州。2007年7月至2009年6月期间俄克拉荷马州和俄勒冈州医疗补助计划的医疗补助受益人（俄克拉荷马州33724人，俄勒冈州13520人）主要结局是阿片类药物初治ER/LA阿片类药物使用事件。次要结局包括其他阿片类和非阿片类止痛药的使用。我们还检查了高风险处方（例如高剂量阿片类药物使用）和阿片类药物相关住院或急诊（艾德）就诊的指标。事先授权政策与阿片类药物初治ER/LA阿片类药物使用事件的可能性降低0.7个百分点相关[95%置信区间（CI）=-1.16至-0.33个百分点;政策前平均值降低70%，任何新的ER/LA阿片类药物处方的可能性降低1.4个百分点（95% CI = −2.1至−0.7个百分点;政策前平均减少33%），每名入组者的ER/LA阿片类药物处方总量（PPE）下降0.16（95% CI = −0.29至−0.04 PPE）]。政策后填充的短效阿片类药物数量显著增加（0.36; 95% CI = 0.22-0.50 PPE），阿片类药物和苯二氮卓类药物重叠的可能性增加，但阿片类药物重叠的可能性显著降低。未观察到阿片类药物相关住院或艾德访视的显著变化。在美国俄克拉荷马州，2008年7月的缓释/长效阿片类药物事先授权政策似乎使开始使用缓释/长效阿片类药物的阿片类药物初治患者数量减少了一半以上，但也可能使短效阿片类药物处方增加了7%。
In response to the opioid overdose epidemic, US state Medicaid programs have adopted restrictive policies for opioid analgesics, yet effects on prescribing patterns and health outcomes are uncertain. This study aimed to examine effects of a prior authorization policy for extended-release/long-acting (ER/LA) opioids on opioid use in the Oklahoma, USA state Medicaid program. Retrospective difference-in-differences design study comparing changes in opioid use in Oklahoma Medicaid to control (Oregon Medicaid). Oklahoma and Oregon, USA. Medicaid beneficiaries in the Oklahoma and Oregon fee-for-service Medicaid programs between July 2007 and June 2009 (33724 in Oklahoma and 13520 in Oregon) The primary outcome was incident opioid-naive ER/LA opioid use. Secondary outcomes included other opioid and non-opioid pain medication use. We also examined indicators of high-risk prescribing (e.g. high-dosage opioid use) and opioid-related hospitalizations or emergency department (ED) visits. The prior authorization policy was associated with a 0.7 percentage point reduction in the likelihood of incident opioid-naive ER/LA opioid use [95% confidence interval (CI) = −1.16 to −0.33 percentage points; 70% pre-policy mean reduction, a 1.4 percentage point decrease in likelihood of any new ER/LA opioid prescriptions (95% CI = −2.1 to −0.7 percentage points; 33% pre-policy mean reduction) and a decline of 0.16 in total ER/LA opioid prescriptions per enrollee (PPE) (95% CI = −0.29 to −0.04 PPE)]. There was a significant increase in the number of short-acting opioids filled after the policy (0.36; 95% CI = 0.22–0.50 PPE), increases in likelihood of having overlapping opioids and benzodiazepines, but significant reductions in likelihood of having overlapping opioids. No significant changes in opioid-related hospitalizations or ED visits were observed. In Oklahoma, USA’s July 2008 prior authorization policy for extended-release/long-acting opioids appears to have reduced the number of opioid-naive patients initiating extended-release/long-acting opioid use by more than half, but may also have increased short-acting opioid prescriptions by 7%.
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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：
39.2
作者：
Dunn, Kate M.;Saunders, Kathleen W.;Von Korff, Michael
通讯作者：
Von Korff, Michael
影响因子：
39
作者：
Miller, Matthew;Barber, Catherine W.;Gagnon, David R.
通讯作者：
Gagnon, David R.
DOI：
10.1016/j.sapharm.2015.04.003
发表时间：
2016-01-01
影响因子：
3.9
作者：
Keast, Shellie L.;Farmer, Kevin;Harrison, Donald
通讯作者：
Harrison, Donald
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R