National Patterns of Codeine Prescriptions for Children in the Emergency Department
National Patterns of Codeine Prescriptions for Children in the Emergency Department
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DOI：
10.1542/peds.2013-3171
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发表时间：
2014-05-01
期刊：
影响因子：
8
通讯作者：
Bardach, Naomi S.
中科院分区：
文献类型：
--
作者：
Kaiser, Sunitha V.;Asteria-Penaloza, Renee;Bardach, Naomi S.
背景和目的：国家指南建议不要在儿童中使用可待因，但对美国的处方模式知之甚少。我们的目标是评估儿科可待因处方在全国范围内随时间的变化，并确定与可待因处方相关的因素。方法：在具有全国代表性的全国医院非卧床医疗护理调查中，我们对3至17岁患者的急诊科就诊进行了一系列横断面分析(2001-2010)。我们确定了可待因处方的调查加权年率，并测试了随时间的线性趋势。我们使用多变量Logistic回归来确定与可待因处方相关的特征，并使用中断时间序列分析来评估与两个2006年建议不使用可待因处方的国家指南相关的上呼吸道感染(URI)或咳嗽处方的变化。结果：在研究期间，使用可待因处方的就诊比例(N=1.89亿)从3.7%下降到2.9%(P=0.008)。使用可待因处方的几率在8至12岁的儿童中更高(优势比[OR]，1.42；95%可信区间[1.21-1.67])，在东北以外的提供者中。非西班牙裔黑人儿童(OR，0.67[0.56-0.8])或接受医疗补助的儿童(OR，0.84[0.71-0.98])的几率较低。2006年的指南与咳嗽或URI的可待因处方的减少无关。结论：尽管10年来可待因处方略有下降，但在国家指南建议不要使用可待因处方后，咳嗽或URI的使用并未减少。需要更有效的干预措施来预防儿童开可待因处方。
BACKGROUND AND OBJECTIVES:National guidelines have recommended against codeine use in children, but little is known about prescribing patterns in the United States. Our objectives were to assess changes over time in pediatric codeine prescription rates in emergency departments nationally and to determine factors associated with codeine prescription.METHODS:We performed a serial cross-sectional analysis (2001-2010) of emergency department visits for patients ages 3 to 17 years in the nationally representative National Hospital Ambulatory Medical Care Survey. We determined survey-weighted annual rates of codeine prescriptions and tested for linear trends over time. We used multivariate logistic regression to identify characteristics associated with codeine prescription and interrupted time-series analysis to assess changes in prescriptions for upper respiratory infection (URI) or cough associated with two 2006 national guidelines recommending against its use for these indications.RESULTS:The proportion of visits (N = 189 million) with codeine prescription decreased from 3.7% to 2.9% during the study period (P = .008). Odds of codeine prescription were higher for children ages 8 to 12 years (odds ratio [OR], 1.42; 95% confidence interval [1.21-1.67]) and among providers outside the northeast. Odds were lower for children who were non-Hispanic black (OR, 0.67 [0.56-0.8]) or with Medicaid (OR, 0.84 [0.71-0.98]). The 2006 guidelines were not associated with a decline in codeine prescriptions for cough or URI visits.CONCLUSIONS:Although there was a small decline in codeine prescription over 10 years, use for cough or URI did not decline after national guidelines recommending against its use. More effective interventions are needed to prevent codeine prescription to children.