The Effect of Opioid Prescribing Guidelines on Prescriptions by Emergency Physicians in Ohio
The Effect of Opioid Prescribing Guidelines on Prescriptions by Emergency Physicians in Ohio
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DOI：
10.1016/j.annemergmed.2017.03.057
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发表时间：
2017-12-01
影响因子：
6.2
通讯作者：
Schuur, Jeremiah D.
中科院分区：
文献类型：
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作者：
Weiner, Scott G.;Baker, Olesya;Schuur, Jeremiah D.
研究目的：本研究的目的是评估俄亥俄州2012年4月旨在减少不适当阿片类药物处方的急诊医生指南与急诊医生开具的阿片类药物处方的数量和类型之间的关系。方法：我们使用俄亥俄州2010年1月1日至2014年12月31日的处方药监测项目数据，纳入5种最常用的阿片类药物（氢可酮、羟考酮、曲马多、可待因和氢吗啡酮）。主要结果是俄亥俄州急诊医生每月在全州范围内开出的阿片类药物处方总数。我们采用中断时间序列分析比较指南出台前后急诊医生每月开具的阿片类药物处方数量、按5种常用阿片类药物分层的处方数量以及超过3天阿片类药物供应的处方数量的水平和趋势。结果：从2010年1月开始，俄亥俄州所有急诊医生开出的处方数量每月下降0.3%（95%置信区间[CI] -0.49%至-0.15%）。2012年4月指南的实施与每月全州总处方水平下降12% （95% CI -17.7%至-6.3%）相关，并且相对于指南前期趋势又下降0.9% （95% CI -1.1%至-0.7%）。指南对每月总处方大于3天供应的估计影响是11.2%的水平下降（95% CI -18.8%至-3.6%），并且在指南之后每月趋势下降0.9% （95% CI -1.3%至-0.5%）。指南还与减少5种阿片类药物的处方有关，效果各不相同。结论：在俄亥俄州，急诊医生阿片类药物处方指南与急诊医生开具的阿片类药物处方数量的减少有关。尽管指南的引入与其他阿片类药物相关干预措施同时发生，但我们的研究结果表明，指南对处方行为有额外的影响。类似的指南也有可能减少其他地理区域和其他专业的阿片类药物处方。
Study objective: The objective of our study is to evaluate the association between Ohio's April 2012 emergency physician guidelines aimed at reducing inappropriate opioid prescribing and the number and type of opioid prescriptions dispensed by emergency physicians.Methods: We used Ohio's prescription drug monitoring program data from January 1, 2010, to December 31, 2014, and included the 5 most commonly prescribed opioids (hydrocodone, oxycodone, tramadol, codeine, and hydromorphone). The primary outcome was the monthly statewide prescription total of opioids written by emergency physicians in Ohio. We used an interrupted time series analysis to compare pre- and postguideline level and trend in number of opioid prescriptions dispensed by emergency physicians per month, number of prescriptions stratified by 5 commonly prescribed opioids, and number of prescriptions for greater than 3 days' supply of opioids.Results: Beginning in January 2010, the number of prescriptions dispensed by all emergency physicians in Ohio decreased by 0.3% per month (95% confidence interval [CI] -0.49% to -0.15%). The implementation of the guidelines in April 2012 was associated with a 12% reduction (95% CI -17.7% to -6.3%) in the level of statewide total prescriptions per month and an additional decline of 0.9% (95% CI -1.1% to -0.7%) in trend relative to the preguideline trend. The estimated effect of the guidelines on total monthly prescriptions greater than a 3-day supply was an 11.2% reduction in level (95% CI -18.8% to -3.6%) and an additional 0.9% (95% CI -1.3% to -0.5%) decline in trend per month after the guidelines. Guidelines were also associated with a reduction in prescribing for each of the 5 individual opioids, with various effect.Conclusion: In Ohio, emergency physician opioid prescribing guidelines were associated with a decrease in the quantity of opioid prescriptions written by emergency physicians. Although introduction of the guidelines occurred in parallel with other opioid-related interventions, our findings suggest an additional effect of the guidelines on prescribing behavior. Similar guidelines may have the potential to reduce opioid prescribing in other geographic areas and for other specialties as well.