Guideline adherence and reasons for recommending dose reduction in a primary care-based opioid management clinic.
Guideline adherence and reasons for recommending dose reduction in a primary care-based opioid management clinic.
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DOI：
10.5055/jom.2021.0682
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发表时间：
2021-11
影响因子：
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通讯作者：
Starrels, Joanna L
中科院分区：
文献类型：
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作者：
Khalid, Laila;Roth, Serena;Zhang, Chenshu;Burkenroad, Aaron;Carrozzi, Gianni;Starrels, Joanna L
为了向长期阿片类药物治疗（LTOT）的患者提供CDC指南推荐的实践，包括关于阿片类药物剂量减少的个性化决定，我们开发了Power Over Pain（POP）诊所。描述阿片类药物剂量减少的频率和原因以及对CDC指南推荐实践的前后依从性。回顾性病历审查，进行定性和前后分析。在POP诊所至少见到一次在城市内科教学实践中开具LTOT的患者。阿片类药物剂量减少定义为首次POP诊所访视后6个月和12个月时吗啡等效日剂量（MEDD）的减少，使用配对t检验。在剂量降低的患者中，对POP诊所记录中记录的原因进行了定性检查。使用McNemar检验比较了基线时接受四种CDC指南推荐做法[受控物质协议（CSA）、尿液药物检测（UDT）、处方监测计划审查和纳洛酮分发]与6个月和12个月时的二分测量。在70例患者中，大多数为女性（66%）和西班牙裔（54%）。43例患者（61%）在首次POP门诊访视后12个月内减少了阿片类药物剂量。最常见的原因是继续使用当前剂量的获益较低或不明确（49%）。平均MEDD在6个月时从69 mg降至57 mg（p<0.01），在12个月时降至56 mg（p<0.01）。完成CSA、UDT和纳洛酮分布在6个月和12个月时增加（p<0.01）。在以初级保健为基础的阿片类药物管理诊所进行个体化风险评估是可行的，可以减少阿片类药物剂量并遵守指南。
To provide CDC guideline-recommended practices for patients on long-term opioid therapy (LTOT) including individualized decisions about opioid dose reduction, we developed the Power Over Pain (POP) Clinic. To describe frequency and reasons for opioid dose reduction and pre-post adherence to CDC guideline-recommended practices. Retrospective chart review with qualitative and pre-post analysis. Patients at an urban internal medicine teaching practice prescribed LTOT were seen at POP Clinic at least once. Opioid dose reduction was defined by reduction in morphine-equivalent daily dose (MEDD) at 6 and 12 months after the first POP Clinic visit, using paired t-tests. Among patients with a dose reduction, reasons documented in POP Clinic notes were qualitatively examined. Dichotomous measures of receiving four CDC guideline-recommended practices [controlled substance agreement (CSA), urine drug testing (UDT), prescription monitoring program review, and naloxone dispensing) at baseline vs. 6 and 12 months were compared using McNemar’s tests. Of 70 patients, most were female (66%) and Hispanic (54%). Forty-three patients (61%) had an opioid dose reduction in 12 months after the first POP Clinic visit. The most frequent reason was low or unclear benefit of continuing the current dose (49%). Mean MEDD was reduced from 69mg to 57mg at 6 months (p<0.01) and to 56mg at 12 months (p<0.01). Completing a CSA, UDT, and naloxone distribution increased at 6 and 12 months (p<0.01). Individualized risk assessment in a primary care-based opioid management clinic is feasible and can result in opioid dose reduction and guideline adherence.