Patterns of Initial Opioid Prescribing to Opioid-Naive Patients.
Patterns of Initial Opioid Prescribing to Opioid-Naive Patients.
复制标题
DOI：
10.1097/sla.0000000000002969
复制
发表时间：
2020-02
影响因子：
9
通讯作者：
Brummett CM
中科院分区：
文献类型：
--
作者：
Larach DB;Waljee JF;Hu HM;Lee JS;Nalliah R;Englesbe MJ;Brummett CM
确定opioid-naïve患者接受初始阿片类药物处方期间的护理发作。我们假设，随着新的初级保健和止痛药阿片类药物处方指南的制定，外科、急诊和牙科患者的处方比例增加。大多数阿片类药物相关的发病率和死亡率源于处方阿片类药物或处方使用引起的非医疗阿片类药物误用和滥用。虽然存在慢性使用阿片类药物处方指南，但对于为opioid-naïve患者提供初始阿片类药物处方的护理类型知之甚少。2010-2016年的回顾性横断面研究，使用全国保险索赔数据集研究18至64岁的美国成年人。主要结局是2010年至2016年opioid-naïve接受外科、急诊和牙科护理的患者阿片类药物处方的变化，以及所填阿片类药物的类型和数量。我们确定了opioid-naïve患者填写的16292018张阿片类药物处方。从2010年到2016年，接受手术、急诊和牙科护理的患者的处方总份额增加了15.8%。2016年，外科患者占初始处方的22.0%，急诊患者占13.0%，牙科患者占4.2%；手术患者服用阿片类药物的总剂量最多（403mg口服吗啡当量，SD 1369），每日服用阿片类药物的剂量最多（82mg口服吗啡当量，SD 273），每张处方阿片类药物的天数第二高（5.4天，SD 3.4）。手术患者每份处方的平均口服吗啡总当量从2010年的240 mg （SD 509）增加到2016年的403 mg （SD 1369）。在研究期间，手术患者接受强效阿片类药物的比例最高（90.2%）。相对于初级和慢性疼痛护理，牙科、急诊和外科护理的初始阿片类药物处方正在增加，这可能是由于针对初级保健和疼痛医生的阿片类药物处方指南的出现。这些数据强调了为这些护理事件制定处方指南的重要性，在此期间，为opioid-naïve患者开出的阿片类药物数量最多。对于哪些类型的护理opioid-naïve患者处方阿片类药物？在首次使用阿片类药物的患者中，我们观察到，从2010年到2016年，外科、牙科和急诊护理后使用阿片类药物的比例增加了15.8%。此类护理事件是opioid-naïve患者阿片类药物处方比例上升的原因，应成为制定最佳实践指南的重点。
To determine the episodes of care during which opioid-naïve patients receive initial opioid prescriptions. We hypothesized that the percentage of prescriptions to surgical, emergency medicine, and dental patients increased as new primary care and pain medicine opioid prescribing guidelines were developed. Most opioid-related morbidity and mortality derives from prescribed opioids or from nonmedical opioid misuse and abuse stemming from prescription use. Although guidelines exist for opioid prescribing in the setting of chronic use, much less is known regarding the types of care for which opioid-naïve patients are provided an initial opioid prescription. Retrospective cross-sectional study over 2010–2016 using a nationwide insurance claims dataset to study US adults aged 18 to 64 years. The primary outcome was change in opioid prescriptions for opioid-naïve patients undergoing surgical, emergency, and dental care from 2010 to 2016, and the type and amounts of opioid filled. We identified 16,292,018 opioid prescriptions filled by opioid-naïve patients. The combined share of prescriptions for patients receiving surgery, emergency, and dental care increased by 15.8% from 2010 to 2016. In 2016, surgery patients filled 22.0% of initial prescriptions, emergency medicine patients 13.0%, and dental patients 4.2%; surgical patients received the most total (403 mg oral morphine equivalents, SD 1369) and daily (82 mg oral morphine equivalents, SD 273) opioid amounts, and the second-highest number of days of opioid per prescription (5.4, SD 3.4). Surgical patients’ mean total oral morphine equivalents per prescription increased from 240 mg (SD 509) in 2010 to 403 mg (SD 1369) in 2016. Over the study period, surgical patients received the highest proportion of potent opioids (90.2%). Initial opioid prescribing attributable to dental, emergency, and surgical care is increasing relative to primary and chronic pain care, possibly due to the advent of opioid prescribing guidelines for primary care and pain physicians. These data emphasize the importance of developing prescribing guidelines for these episodes of care, during which the highest amounts of opioids are prescribed to opioid-naïve patients. For what types of care are opioid-naïve patients prescribed opioids? Among opioid-naive patients, we observed a 15.8% increase in the proportion of opioid prescriptions filled following surgical, dental, and emergency care from 2010 to 2016. Such care episodes are responsible for a rising proportion of opioid prescribing to opioid-naïve patients and should be the focus of efforts to create best practice guidelines.