The ecology of prescription opioid abuse in the USA: geographic variation in patients' use of multiple prescribers ("doctor shopping").
The ecology of prescription opioid abuse in the USA: geographic variation in patients' use of multiple prescribers ("doctor shopping").
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DOI：
10.1002/pds.3690
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发表时间：
2014-12
影响因子：
2.6
通讯作者：
Carlson KE
中科院分区：
文献类型：
--
作者：
McDonald DC;Carlson KE
这项研究估计了美国各县使用大量处方的阿片类药物患者的患病率、他们获得的阿片类药物的数量，以及通过各县的生态属性（包括阿片类药物的一般医疗暴露）预测其患病率的程度。使用有限混合模型，使用 2008 年期间发放的 1.46 亿张阿片类药物处方样本，估计拥有可疑大量处方者（可能的医生购买者）的离群患者亚群的规模。县级购买者比例的普通最小二乘回归模型包括衡量县生态属性的自变量，包括患者处方阿片类药物的比例、居民人口的社会经济特征、医生的供应以及医疗保健服务利用率的衡量标准。购物者的比例因县而异，每 1000 名居民中有 0.6 人到 2.5 人之间。购物者患病率与一般人群的阿片类药物处方密切相关，在调整医生供应、急诊科就诊次数、住院天数、贫困率、居住在城市地区的县居民百分比以及居民人口的种族/民族构成后，占观察到的购物者患病率各县差异的 30%。大约 30% 的购物者在多个州获得了处方。一个县的医生购物者和阿片类药物患者的患病率之间的相关性可能表明，容易获得合法医疗会增加滥用的风险，或者药物滥用者会在容易获得的地方利用更多机会。讨论了防止过度使用不同处方者的方法。
This study estimates the prevalence in US counties of opioid patients who use large numbers of prescribers, the amounts of opioids they obtain, and the extent to which their prevalence is predicted by ecological attributes of counties, including general medical exposure to opioids. Finite mixture models were used to estimate the size of an outlier subpopulation of patients with suspiciously large numbers of prescribers (probable doctor shoppers), using a sample of 146 million opioid prescriptions dispensed during 2008. Ordinary least squares regression models of county-level shopper rates included independent variables measuring ecological attributes of counties, including rates of patients prescribed opioids, socioeconomic characteristics of the resident population, supply of physicians, and measures of healthcare service utilization. The prevalence of shoppers varied widely by county, with rates ranging between 0.6 and 2.5 per 1000 residents. Shopper prevalence was strongly correlated with opioid prescribing for the general population, accounting for 30% of observed county variation in shopper prevalence, after adjusting for physician supply, emergency department visits, in-patient hospital days, poverty rates, percent of county residents living in urban areas, and racial/ethnic composition of resident populations. Approximately 30% of shoppers obtained prescriptions in multiple states. The correlation between prevalence of doctor shoppers and opioid patients in a county could indicate either that easy access to legitimate medical treatment raises the risk of abuse or that drug abusers take advantage of greater opportunities in places where access is easy. Approaches to preventing excessive use of different prescribers are discussed.