Opioid analgesic and benzodiazepine prescribing among Medicaid-enrollees with opioid use disorders: The influence of provider communities.
Opioid analgesic and benzodiazepine prescribing among Medicaid-enrollees with opioid use disorders: The influence of provider communities.
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DOI：
10.1080/10550887.2016.1211784
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发表时间：
2017-01
影响因子：
2.3
通讯作者：
Liccardo Pacula R
中科院分区：
文献类型：
--
作者：
Stein BD;Mendelsohn J;Gordon AJ;Dick AW;Burns RM;Sorbero M;Shih RA;Liccardo Pacula R
阿片类药物使用障碍（OUD）患者使用阿片类镇痛剂和苯二氮卓类药物可增加医疗后果和复发的风险。关于这些药物的使用率或处方社区中的处方模式知之甚少。检查在OUD诊断后的日历年内向医疗补助注册者开具处方的比率，并检查与此类处方相关的个人、县和提供者社区因素。我们使用了来自12个州的2008年医疗补助索赔数据来确定诊断为OUD的登记者，并使用2009年索赔数据来确定每种药物的处方率。我们使用社会网络分析来确定供应商社区和多元回归分析，以确定患者，县和供应商社区水平的因素与处方这些药物。我们还研究了不同供应商社区的处方率变化。在被确定为OUD的医疗补助注册者中，45%的人在诊断后的一年内服用阿片类镇痛药，37%服用苯二氮卓类药物，21%服用这两种药物。女性、老年人、疼痛综合征患者以及居住在贫困率较高的县的个人更有可能填写处方。处方率在提供者社区之间差异很大，处方社区最高四分位数的处方率是最低处方社区的2.5倍以上。向诊断为OUD的患者开具阿片类镇痛药和苯二氮卓类药物可能会增加复发和过量的风险。应考虑针对处方率最高的提供者社区和风险最高的个人采取干预措施。
Opioid analgesic and benzodiazepine use in individuals with opioid use disorders (OUDs) can increase the risk for medical consequences and relapse. Little is known about rates of use of these medications or prescribing patterns among communities of prescribers. To examine rates of prescribing to Medicaid-enrollees in the calendar year after an OUD diagnosis, and to examine individual, county, and provider community factors associated with such prescribing. We used 2008 Medicaid claims data from 12 states to identify enrollees diagnosed with OUDs, and 2009 claims data to identify rates of prescribing of each drug. We used social network analysis to identify provider communities and multivariate regression analyses to identify patient, county, and provider community level factors associated with prescribing these drugs. We also examined variation in rates of prescribing across provider communities. Among Medicaid-enrollees identified with an OUD, 45% filled a prescription for an opioid analgesic, 37% for a benzodiazepine, and 21% for both in the year following their diagnosis. Females, older individuals, individuals with pain syndromes, and individuals residing in counties with higher rates of poverty were more likely to fill prescriptions. Prescribing rates varied substantially across provider communities, with rates in the highest quartile of prescribing communities over 2.5 times the rates in the lowest prescribing communities. Prescribing opioid analgesics and benzodiazepines to individuals diagnosed with OUDs may increase risk of relapse and overdose. Interventions should be considered that target provider communities with the highest rates of prescribing and individuals at highest risk.