Trends and geographic variation of opiate medication use in state Medicaid fee-for-service programs, 1996 to 2002
Trends and geographic variation of opiate medication use in state Medicaid fee-for-service programs, 1996 to 2002
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DOI：
10.1097/01.mlr.0000228025.04535.25
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发表时间：
2006-11-01
期刊：
影响因子：
3
通讯作者：
Sullivan, Sean D.
中科院分区：
文献类型：
--
作者：
Zerzan, Judy T.;Morden, Nancy E.;Sullivan, Sean D.
背景资料：虽然研究已经记录了医院和手术服务的地理差异，处方使用的地理差异在很大程度上是未知的。阿片类止痛药被广泛使用，特别是因为颁布了临床指南，促进积极的疼痛治疗。本研究描述了时间和州际变异性，在美国Medicaid programmes.Methods内的总处方阿片类药物的使用：一个数据集的49个州的收费服务（FFS）从1996年至2002年的Medicaid处方药配药记录进行了编译，并用于量化药物配药检查所有阿片类药物，控释羟考酮，美沙酮。计算了所有阿片类药物类别的定义日剂量（DDD）/1000名FFS Medicaid成人登记者每天。一个市场篮子的非疼痛处方药进行比较。率，趋势，和变异系数的整体确定，按年和each state.Results：从1996年至2002年，阿片类止痛药的总体使用增加了309%。市场购物篮的使用量增加了170%。鸦片剂总分配量各州之间差异很大，1996年为6.9至44.1 DDD/1000/d，2002年为7.1至165.0 DDD/1000/d（相差23倍）。2002年的变异系数为49.6。控释羟考酮和美沙酮有一个更大的增长率相比，所有opiate.Conclusions：阿片类药物在医疗补助计划中的配药增加了近两倍的非疼痛相关药物在7年的研究期间。在总体使用方面存在着巨大的、无法解释的地理差异。应调查医疗补助成本控制策略对利用率和结果的影响。
Background: Although studies have documented hospital and surgical service geographic variability, prescription use geographic variability is largely unknown. Opiate pain medications are widely used, particularly because the promulgation of clinical guidelines promoting aggressive pain treatment. This study describes temporal and interstate variability in aggregate prescription opiate medication use within U.S. Medicaid programs.Methods: A dataset of 49 states' fee-for-service (FFS) Medicaid prescription drug dispensing records from 1996 to 2002 was compiled and used to quantify medication dispensing examining all opiates, controlled release oxycodone, and methadone. The defined daily dose (DDD) per 1000 FFS Medicaid adult enrollees per day was calculated for all opiate medication categories. A market basket of nonpain prescription medications was constructed for comparison. Rates, trends, and the coefficient of variation were determined overall, by year and for each state.Results: From 1996 to 2002, overall use of opiate pain medications increased 309%. The market basket use increased 170%. Total opiate dispensing varied widely from state to state, with a range of 6.9 to 44.1 DDD/1000/d in 1996, and 7.1 to 165.0 DDD/1000/d (a 23-fold difference) in 2002. The coefficient of variation was 49.6 in 2002. Controlled release oxycodone and methadone had a greater rate of increase compared with all opiates.Conclusions: The dispensing of opiate medications in Medicaid programs increased at almost twice the rate of nonpain-related medications during the 7-year study period. Large, unexplained geographic variation in aggregate use exists. The impact of Medicaid cost-containment strategies on utilization and outcomes should be investigated.