Prescription coverage in indigent patients affects the use of long-acting opioids in the management of cancer pain.
Prescription coverage in indigent patients affects the use of long-acting opioids in the management of cancer pain.
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DOI：
10.1111/pme.12238
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
Amadio WJ
中科院分区：
文献类型：
--
作者：
Wieder R;Delarosa N;Bryan M;Hill AM;Amadio WJ
我们测试了这样一个假设，即处方覆盖率会影响对患有癌症疼痛的贫困市中心少数民族患者开出长效阿片类药物的处方。我们对在UMDNJ大学医院肿瘤科接受治疗的360名患者进行了图表回顾，这些患者服用了阿片类止痛药。一半的患者是慈善护理或自付(CC/SP)，没有处方药保险的好处，一半的患者有医疗补助，无限制的处方药保险。我们评估了住院出院的患者，他们随后进行了三次门诊随访。我们比较了人口统计学、疼痛强度、阿片类药物的类型和剂量、对处方疼痛方案的坚持、非计划的急诊科(ED)就诊和非计划的住院。在医疗补助组中，长效阿片类药物的使用明显多于CC/SP组。医疗补助组有明显更多的非裔美国人患者，吸烟率和药物使用率更高，CC/SP组不成比例地更多的西班牙裔和亚洲患者，吸烟和药物使用更少。西班牙裔和亚洲患者不太可能服用长效阿片类药物。疼痛程度和依从性在两组中是相同的，除了疾病阶段之外，不受任何这些变量的影响，这在两组中是平均分布的。对于同等水平的癌症疼痛，适当使用长效阿片类药物只受处方覆盖范围的影响。没有处方覆盖和接受较少长效阿片类药物的人群中，西班牙裔和亚洲患者比例较高。
We tested the hypothesis that prescription coverage affects the prescribing of long-acting opiates to indigent inner city minority patients with cancer pain. We conducted a chart review of 360 patients treated in the Oncology Practice at UMDNJ-University Hospital, who were prescribed opiate pain medications. Half the patients were Charity Care or Self Pay (CC/SP), without the benefit of prescription coverage, and half had Medicaid, with unlimited prescription coverage. We evaluated patients discharged from a hospitalization, who had three subsequent outpatient follow up visits. We compared demographics, pain intensity, the type and dose of opiates, adherence to prescribed pain regimen, unscheduled Emergency Department (ED) visits and unscheduled hospitalizations. There was a significantly greater use of long-acting opiates in the Medicaid group than in the CC/SP group. The Medicaid group had significantly more African American patients and a greater rate of smoking and substance use and the CC/SP group disproportionately more Hispanic and Asian patients and less smoking and substance use. Hispanic and Asian patients were less likely to have long-acting opiates prescribed to them. Pain levels and adherence were equivalent in both groups and were not affected by any of these variables except stage of disease, which was equally distributed in the two groups. Appropriate use of long-acting opiates for equivalent levels of cancer pain are influenced only by the availability of prescription coverage. The group without prescription coverage and receiving fewer long-acting opiates had disproportionately more Hispanic and Asian patients.
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影响因子：
45.3
作者：
Rhodes, DJ;Koshy, RC;Grossman, SA
通讯作者：
Grossman, SA
影响因子：
3.1
作者：
Bryan, Margarette;De La Rosa, Nila;Wieder, Robert
通讯作者：
Wieder, Robert
影响因子：
45.3
作者：
Du Pen, SL;Du Pen, AR;Syrjala, K
通讯作者：
Syrjala, K
影响因子：
7.4
作者：
Klepstad, P;Kaasa, S;Borchgrevink, PC
通讯作者：
Borchgrevink, PC
影响因子：
7.4
作者：
Edwards, RR;Fillingim, RB;Ness, TJ
通讯作者：
Ness, TJ