Changes in postoperative opioid prescribing across three diverse healthcare systems, 2010-2020.
Changes in postoperative opioid prescribing across three diverse healthcare systems, 2010-2020.
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DOI：
10.3389/fdgth.2022.995497
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发表时间：
2022
影响因子：
--
通讯作者：
Hernandez-Boussard, Tina
中科院分区：
文献类型：
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作者：
Coquet, Jean;Zammit, Alban;El Hajouji, Oualid;Humphreys, Keith;Asch, Steven M.;Osborne, Thomas F.;Curtin, Catherine M.;Hernandez-Boussard, Tina
阿片类药物危机引发了对阿片类药物处方的审查。了解阿片类药物处方模式和相应的患者结果在流行病期间如何变化对于未来的有针对性的政策至关重要。许多研究试图模拟阿片类药物处方的趋势，因此有必要了解不同人群阿片类药物处方模式的时间变化。本研究描述了 2010 年至 2020 年不同人群术后阿片类药物处方模式。来自退伍军人健康管理局 (VHA)、六个医疗补助州计划和一个学术医疗中心 (AMC) 的行政数据。使用临床分类软件来识别手术。使用回归和似然比检验统计数据比较平均每日排出吗啡毫克当量 (MME)、术后疼痛和随后的阿片类药物处方的趋势。这些队列包括 595,106 名患者，这些患者的人口统计数据差异很大。在研究期间，VHA（37.5-30.1；p = 0.002）和医疗补助（41.6-31.3；p = 0.019）时，MME 显着下降，而 AMC（36.9-41.7；p< 0.001）时，MME 显着增加。 2015 年之后，VHA (p< 0.001) 和 Medicaid (p= 0.002) 中的持续阿片类药物使用者有所减少，而 AMC 中的持续阿片类药物使用者有所增加 (p = 0.003)，但仍维持在较低水平。在研究期间平均术后疼痛评分保持不变。 VHA 和医疗补助计划在过去十年中减少了阿片类药物的处方，但响应时间和比率有所不同。 2020 年，尽管人口差异很大，这些系统仍实现了类似的阿片类药物处方模式和结果。承认这些时间分布变化并将其纳入数据学习模型对于稳健且可推广的模型至关重要。
The opioid crisis brought scrutiny to opioid prescribing. Understanding how opioid prescribing patterns and corresponding patient outcomes changed during the epidemic is essential for future targeted policies. Many studies attempt to model trends in opioid prescriptions therefore understanding the temporal shift in opioid prescribing patterns across populations is necessary. This study characterized postoperative opioid prescribing patterns across different populations, 2010–2020. Administrative data from Veteran Health Administration (VHA), six Medicaid state programs and an Academic Medical Center (AMC). Surgeries were identified using the Clinical Classifications Software. Trends in average daily discharge Morphine Milligram Equivalent (MME), postoperative pain and subsequent opioid prescription were compared using regression and likelihood ratio test statistics. The cohorts included 595,106 patients, with populations that varied considerably in demographics. Over the study period, MME decreased significantly at VHA (37.5–30.1; p = 0.002) and Medicaid (41.6–31.3; p = 0.019), and increased at AMC (36.9–41.7; p < 0.001). Persistent opioid users decreased after 2015 in VHA (p < 0.001) and Medicaid (p = 0.002) and increase at the AMC (p = 0.003), although a low rate was maintained. Average postoperative pain scores remained constant over the study period. VHA and Medicaid programs decreased opioid prescribing over the past decade, with differing response times and rates. In 2020, these systems achieved comparable opioid prescribing patterns and outcomes despite having very different populations. Acknowledging and incorporating these temporal distribution shifts into data learning models is essential for robust and generalizable models.
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