A statewide evaluation of seven strategies to reduce opioid overdose in North Carolina.
A statewide evaluation of seven strategies to reduce opioid overdose in North Carolina.
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DOI：
10.1136/injuryprev-2017-042396
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Dasgupta N
中科院分区：
文献类型：
--
作者：
Alexandridis AA;McCort A;Ringwalt CL;Sachdeva N;Sanford C;Marshall SW;Mack K;Dasgupta N
为了应对日益增加的阿片类药物过量使用，美国的预防工作主要集中在处方者教育以及减少供应、需求和危害的战略上。有限的证据表明哪些干预措施是有效的。我们评估了 Lazarus 项目，这是一项旨在防止阿片类药物过量使用的集中全州干预措施。七种策略的观察性干预研究。北卡罗来纳州 100 个县中有 74 个县实施了干预措施。按县月为每个策略构建二分变量。暴露数据包括：过程日志、调查、成瘾治疗访谈、处方药监测数据。结果是：意外和不确定的阿片类药物过量死亡、与过量相关的急诊科 (ED) 就诊。使用间断时间序列泊松回归来估计干预前（2009-2012）和干预期间（2013-2014）的比率。调整后的 IRR 控制处方、县健康状况和时间趋势。时滞回归模型考虑了延迟影响（0-6 个月）。在调整后的即时影响模型中，提供者教育与较低的药物过量死亡率相关（IRR 0.91；95% CI 0.81 至 1.02），但与药物过量相关的急诊就诊几乎没有变化。限制急诊科阿片类药物配药的政策与较低的死亡率相关（IRR 0.97；95% CI 0.87 至 1.07），但急诊就诊次数较高（IRR 1.06；95% CI 1.01 至 1.12）。在时滞模型中，药物辅助治疗 (MAT) 的扩展与死亡率增加相关（IRR 1.22；95% CI 1.08 至 1.37），但急诊就诊率较低。与疼痛管理和成瘾治疗相关的提供者教育以及限制阿片类药物配发的急诊室政策显示死亡率略有立即下降。尽管与死亡率存在意想不到的不利关联，但在时滞模型中，MAT 扩展在减少 ED 相关过量就诊方面显示出有益的效果。
In response to increasing opioid overdoses, US prevention efforts have focused on prescriber education and supply, demand and harm reduction strategies. Limited evidence informs which interventions are effective. We evaluated Project Lazarus, a centralised statewide intervention designed to prevent opioid overdose. Observational intervention study of seven strategies. 74 of 100 North Carolina counties implemented the intervention. Dichotomous variables were constructed for each strategy by county-month. Exposure data were: process logs, surveys, addiction treatment interviews, prescription drug monitoring data. Outcomes were: unintentional and undetermined opioid overdose deaths, overdose-related emergency department (ED) visits. Interrupted time-series Poisson regression was used to estimate rates during preintervention (2009–2012) and intervention periods (2013–2014). Adjusted IRR controlled for prescriptions, county health status and time trends. Time-lagged regression models considered delayed impact (0–6 months). In adjusted immediate-impact models, provider education was associated with lower overdose mortality (IRR 0.91; 95% CI 0.81 to 1.02) but little change in overdose-related ED visits. Policies to limit ED opioid dispensing were associated with lower mortality (IRR 0.97; 95% CI 0.87 to 1.07), but higher ED visits (IRR 1.06; 95% CI 1.01 to 1.12). Expansions of medication-assisted treatment (MAT) were associated with increased mortality (IRR 1.22; 95% CI 1.08 to 1.37) but lower ED visits in time-lagged models. Provider education related to pain management and addiction treatment, and ED policies limiting opioid dispensing showed modest immediate reductions in mortality. MAT expansions showed beneficial effects in reducing ED-related overdose visits in time-lagged models, despite an unexpected adverse association with mortality.
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DOI：
10.1093/pm/pnw129
发表时间：
2017-01-01
期刊：
Pain medicine (Malden, Mass.)
影响因子：
--
作者：
Cepeda MS;Coplan PM;Kopper NW;Maziere JY;Wedin GP;Wallace LE
通讯作者：
Wallace LE
影响因子：
33.9
作者：
Gladden, R. Matthew;Martinez, Pedro;Seth, Puja
通讯作者：
Seth, Puja
DOI：
10.3109/15360288.2012.680013
发表时间：
2012-06-01
影响因子：
1.1
作者：
通讯作者：
--
影响因子：
4.2
作者：
Dasgupta, Nabarun;Creppage, Kathleen;Proescholdbell, Scott K.
通讯作者：
Proescholdbell, Scott K.
影响因子：
4.2
作者：
Kegler, MC;Steckler, A;Malek, SH
通讯作者：
Malek, SH