Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018.
Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018.
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DOI：
10.1016/j.adaj.2021.01.001
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Nalliah RP
中科院分区：
文献类型：
--
作者：
Chua KP;Hu HM;Waljee JF;Brummett CM;Nalliah RP
目前还没有全国性研究确定哪些手术是美国牙科阿片类药物处方最多的手术，也没有评估这些手术最近的阿片类药物处方模式，这阻碍了牙科阿片类药物管理计划的最佳目标。我们分析了2013-2018年IBM MarketScan牙科，商业和医疗补助多州数据库的索赔数据。在接受120种牙科手术之一的13-64岁患者中，我们确定了在手术日期至术后3天分发的阿片类药物处方（“初始处方”）。对于占初始处方比例最高的5种手术，我们拟合了线性回归模型，评估≥1次初始处方的概率和平均总吗啡毫克当量（MME）处方（阿片类药物量的标准化测量）的趋势。根据人口统计学特征和合并症调整回归。样本中的9，482，976例手术与2，721，688张初始处方相关，其中5种手术占95.2%：拔牙（65.2%）、以问题为中心的有限口腔评估（17.2%）、牙髓治疗（8.4%）、牙槽成形术（2.9%）和外科植入服务（1.5%）。在5种程序中，≥1次初始处方的概率的中位调整后年度变化为−1.3个百分点，平均总MME（约1片含5 mg氢可酮）的中位调整后年度变化为−4.5 MME。2018年，45.3%的拔牙导致≥1次初始处方。五种程序占牙科阿片类药物处方的95%;拔牙占三分之二。用于拔牙的阿片类药物处方正在减少，但即使非阿片类药物是有效的镇痛剂，仍然很常见。消除拔牙的常规处方可以大大减少牙科阿片类药物的暴露。
No national study has identified which procedures account for the most U.S. dental opioid prescriptions or assessed recent opioid prescribing patterns for these procedures, impeding optimal targeting of dental opioid stewardship initiatives. We analyzed claims data from the 2013–2018 IBM MarketScan Dental, Commercial, and Medicaid Multi-State Databases. Among patients aged 13–64 years undergoing one of 120 dental procedures, we identified opioid prescriptions dispensed on the date of procedures to 3 days afterwards (“initial prescriptions”). For the procedures accounting for the 5 highest proportions of initial prescriptions, we fitted linear regression models assessing trends in the probability of ≥1 initial prescription and mean total morphine milligram equivalents (MME) prescribed, a standardized measure of opioid amount. Regressions adjusted for demographic characteristics and co-morbidities. The 9,482,976 procedures in the sample were associated with 2,721,688 initial prescriptions, of which 5 procedures accounted for 95.2%: tooth extraction (65.2%), problem-focused limited oral evaluation (17.2%), endodontic therapy (8.4%), alveoloplasty (2.9%), and surgical implant services (1.5%). Among the 5 procedures, the median adjusted annual change was −1.3 percentage points for probability of ≥1 initial prescription and −4.5 MME for mean total MME (roughly 1 pill containing 5 mg hydrocodone). In 2018, 45.3% of tooth extractions resulted in ≥1 initial prescription. Five procedures account for 95% of dental opioid prescriptions; tooth extraction accounts for two-thirds. Opioid prescribing for tooth extractions is declining but remains common even though non-opioids are effective analgesics. Eliminating routine prescribing for tooth extraction could substantially reduce dental opioid exposure.
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影响因子：
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作者：
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DOI：
10.14219/jada.archive.2013.0207
发表时间：
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影响因子：
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作者：
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