Association of opioid utilization management with prescribing and overdose.
Association of opioid utilization management with prescribing and overdose.
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DOI：
10.37765/ajmc.2022.88829
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发表时间：
2022-02-01
期刊：
影响因子：
--
通讯作者：
Alexander GC
中科院分区：
文献类型：
--
作者：
Andersen MS;Lorenz V;Pant A;Bray JW;Alexander GC
处方阿片类药物造成的死亡在美国已经达到流行水平，但人们对保险公司的保险政策如何影响服用阿片类药物处方的人中致命和非致命过量的比率知之甚少。使用2010-2016年医疗保险索赔数据进行的回溯性队列研究，对象是拥有一张或多张处方的附表II阿片类药物的受益人。结果是在处方期间或处方结束后7天内，阿片类药物用量(以毫克吗啡当量(MME)为单位)、供应天数和每个处方以及与阿片类药物过量有关的急诊室或住院患者的药丸数量。附表二阿片类药物处方703万张，分发给187万份D部分受益年度。703万张阿片类药物处方与每10000张处方中8.5%的阿片类药物过量有关。PA与每个处方中较大的阿片类药物容量相关(103.6 MME，95%CI36.2-171.0)。ST与更多的供应天数(0.62天，CI 0.10~1.13)和更多的药丸发放(6.12粒，CI 2.17~10.1)相关。QL与较小的阿片类药物容量(24.3Mme，CI 12.3-36.3)和较少的药片分配(2.35片，CI 1.77-2.93)有关。在调整后的模型中，服用需要PA的阿片类药物的受益人每开10000张处方，过量剂量减少3.3%(CI 0.41-6.2)。这些受益人中的阿片类药物使用管理与阿片类药物处方的混合影响有关，事先授权与随后过量服药的可能性降低有关。需要进一步探索利用管理和保险公司政策的影响。医疗保险中的阿片类药物使用管理与阿片类药物处方的混合影响有关，事先授权与随后过量服药的可能性降低有关。
Deaths from prescription opioids have reached epidemic levels in the United States, yet little is known about how insurers’ coverage policies may impact rates of fatal and non-fatal overdose among people filling an opioid prescription. Retrospective cohort study using 2010–2016 Medicare claims data for beneficiaries with one or more filled prescriptions for a Schedule II opioid. Outcomes were opioid volume dispensed in milligrams morphine equivalent (MME), number of days supplied, and number of pills dispensed on each prescription and emergency room or inpatient stay associated with an opioid overdose during a prescription or within 7 days of the end of the prescription. 7.03 million [M] prescriptions for Schedule II opioids were dispensed to 1.87M Part D beneficiary-year. The 7.03M opioid prescriptions were associated with 8.5 opioid overdoses per 10000 prescriptions. PA was associated with larger opioid volumes per prescription (103.6 MME, 95% CI 36.2–171.0). ST was associated with a greater number of days supplied (0.62 days, CI 0.10 – 1.13) and more pills dispensed (6.12 pills, CI 2.17 – 10.1). QL was associated with smaller opioid volumes (24.3 MME, CI 12.3–36.3) and fewer pills dispensed (2.35 pills, CI 1.77–2.93). In adjusted models, beneficiaries filling an opioid requiring PA experienced 3.3 fewer overdoses per 10000 prescriptions (CI 0.41–6.2). Opioid utilization management among these beneficiaries was associated with mixed effects on opioid prescribing, and prior authorization was associated with a decreased likelihood of subsequent overdose. Further work exploring the impact of utilization management and insurer policies is needed. Opioid utilization management in Medicare was associated with mixed effects on opioid prescribing, and prior authorization was associated with a decreased likelihood of subsequent overdose.
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影响因子：
3.5
作者：
Hartung, Daniel M.;Kim, Hyunjee;Ahmed, Sharia M.;Middleton, Luke;Keast, Shellie;Deyo, Richard A.;Zhang, Kun;McConnell, K. John
通讯作者：
McConnell, K. John
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：
5.3
作者：
Buchmueller, Thomas C.;Carey, Colleen
通讯作者：
Carey, Colleen
DOI：
10.1136/bmj.j760
发表时间：
2017-03-14
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Sun EC;Dixit A;Humphreys K;Darnall BD;Baker LC;Mackey S
通讯作者：
Mackey S
影响因子：
6.3
作者：
Kuo, Yong-Fang;Raji, Mukaila A.;Goodwin, James S.
通讯作者：
Goodwin, James S.