Assessment of Opioid Prescribing Patterns in a Large Network of US Community Health Centers, 2009 to 2018.
Assessment of Opioid Prescribing Patterns in a Large Network of US Community Health Centers, 2009 to 2018.
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DOI：
10.1001/jamanetworkopen.2020.13431
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发表时间：
2020-09-01
影响因子：
13.8
通讯作者：
Chamine I
中科院分区：
文献类型：
--
作者：
Muench J;Fankhauser K;Voss RW;Huguet N;Hartung DM;O'Malley J;Bailey SR;Cowburn S;Wright D;Barker G;Ukhanova M;Chamine I
这项横断面研究评估了2009年至2018年在美国经常治疗低收入患者的社区卫生中心网络中的阿片类药物处方模式。安全网诊所中是否有阿片类药物的处方模式？这项横断面研究从2009年1月1日至2018年12月31日期间在社区卫生中心网络接受治疗的患者的电子健康记录中提取了3227459张阿片类药物处方，每100名初级保健患者的处方数量从2009年的110.8减少到2018年的29.1，下降了73.7%。阿片类药物使用的其他指标下降到类似的程度。从2009年1月1日到2018年12月31日，社区卫生中心大型网络中的阿片类药物处方有所减少，这可能反映了联邦，州和地方政策和举措的组合，旨在减少与21世纪初阿片类药物处方增加相关的危害。了解社区卫生中心（CHC）中不成比例地为低收入患者提供服务的阿片类药物处方模式可能有助于指导减少阿片类药物相关危害的策略。评估2009年1月1日至2018年12月31日期间，在服务于高风险患者的安全网诊所网络中的阿片类药物处方模式。对从2009年至2018年在CHC网络（包括17个州的449个诊所）接受治疗的2129097名独特初级保健患者的电子健康记录中提取的3227459张阿片类药物处方进行了横断面研究。所有年龄组均纳入分析。在每个研究年的人群水平上描述了以下措施：（1）按年龄和性别列出的至少有一种阿片类药物处方的患者百分比，（2）每100例患者的阿片类药物处方数量，（3）每100例患者的长效阿片类药物处方数量，（4）每例患者的平均年吗啡毫克当量（MME），（5）每种处方的平均MME，（6）慢性阿片类药物使用者的数量，和（7）高剂量阿片类药物使用者的平均值。研究人群包括2 129 097例患者（1 158 413例女性[54. 4%]），平均（SD）年龄为32. 2（21. 1）岁，共接受3 227 459次阿片类药物处方。在一个日历年内接受至少一种阿片类药物处方的患者比例从2009年的15.9%下降到2018年的5.2%，下降了67.4%。在10年的研究期间，与男性（10.9%）相比，非西班牙裔白色患者（18.1%）接受阿片类药物处方的比例更高，与非西班牙裔黑人患者（9.5%）、自认为是其他种族的非西班牙裔患者（8.0%）和西班牙裔患者（6.9%）相比。每100名患者的阿片类药物处方数量从2009年的110.8下降到2018年的29.1，下降了73.7%。在同一时期，每100名患者的长效阿片类药物数量下降了85.5%，从22.0降至3.2。每名患者的MME从2009年的1682.7下降到2018年的243.1，下降了85.6%。在这项横断面研究中，2009年CHC网络中的阿片类药物处方率高于全国人口估计数，但开始更早，更急剧地下降。这一发现可能反映了联邦、州和诊所层面的危害缓解政策和努力，以及CHC内部强有力的临床质量改进策略。
This cross-sectional study evaluates opioid prescribing patterns from 2009 to 2018 in a network of community health centers that frequently treat low-income patients in the US. Are there prescribing patterns for opioid medications in safety-net clinics? In this cross-sectional study of 3 227 459 opioid prescriptions abstracted from electronic health records of patients treated at a network of community health centers between January 1, 2009, and December 31, 2018, the number of prescriptions per 100 primary care patients decreased 73.7% from 110.8 in 2009 to 29.1 in 2018. Other metrics of opioid use decreased to a similar degree. Opioid prescribing in a large network of community health centers decreased from January 1, 2009, to December 31, 2018, which likely reflects a mix of federal, state, and local policies and initiatives directed at reducing harms associated with increased opioid prescribing in the early 2000s. Understanding opioid prescribing patterns in community health centers (CHCs) that disproportionately serve low-income patients may help to guide strategies to reduce opioid-related harms. To assess opioid prescribing patterns between January 1, 2009, and December 31, 2018, in a network of safety-net clinics serving high-risk patients. Cross-sectional study of 3 227 459 opioid prescriptions abstracted from the electronic health records of 2 129 097 unique primary care patients treated from 2009 through 2018 at a network of CHCs that included 449 clinic sites in 17 states. All age groups were included in the analysis. The following measures were described at the population level for each study year: (1) percentage of patients with at least 1 prescription for an opioid by age and sex, (2) number of opioid prescriptions per 100 patients, (3) number of long-acting opioid prescriptions per 100 patients, (4) mean annual morphine milligram equivalents (MMEs) per patient, (5) mean MME per prescription, (6) number of chronic opioid users, and (7) mean of high-dose opioid users. The study population included 2 129 097 patients (1 158 413 women [54.4%]) with a mean (SD) age of 32.2 (21.1) years and a total of 3 227 459 opioid prescriptions. The percentage of patients receiving at least 1 opioid prescription in a calendar year declined 67.4% from 15.9% in 2009 to 5.2% in 2018. Over the 10-year study period, a greater percentage of women received a prescription (13.1%) compared with men (10.9%), and a greater percentage of non-Hispanic White patients (18.1%) received an opioid prescription compared with non-Hispanic Black patients (9.5%), non-Hispanic patients who self-identified as other races (8.0%), and Hispanic patients (6.9%). The number of opioid prescriptions for every 100 patients decreased 73.7% from 110.8 in 2009 to 29.1 in 2018. The number of long-acting opioids for every 100 patients decreased 85.5% during the same period, from 22.0 to 3.2. The MMEs per patient decreased from 1682.7 in 2009 to 243.1 in 2018, a decline of 85.6%. In this cross-sectional study, the opioid prescribing rate in 2009 in the CHC network was higher than national population estimates but began to decline earlier and more precipitously. This finding likely reflects harm mitigation policies and efforts at federal, state, and clinic levels and strong clinical quality improvement strategies within the CHCs.
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DOI：
10.3122/jabfm.2019.06.190087
发表时间：
2019-11-01
影响因子：
2.9
作者：
Huguet, Nathalie;Angier, Heather;DeVoe, Jennifer E.
通讯作者：
DeVoe, Jennifer E.
影响因子：
5.7
作者：
Hadlandsmyth, Katherine;Mosher, Hilary;Lund, Brian C.
通讯作者：
Lund, Brian C.
影响因子：
5.7
作者：
Oronce, Carlos Irwin A.;Fortuna, Robert J.
通讯作者：
Fortuna, Robert J.
影响因子：
39.2
作者：
Bohnert, Amy S. B.;Guy, Gery P., Jr.;Losby, Jan L.
通讯作者：
Losby, Jan L.
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R