Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims.
Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims.
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DOI：
10.1136/bmj.g1393
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发表时间：
2014-02-19
期刊：
影响因子：
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通讯作者：
Karaca-Mandic P
中科院分区：
文献类型：
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作者：
Jena AB;Goldman D;Weaver L;Karaca-Mandic P
目的评估医疗保险中多个提供者开具阿片类药物处方的频率和特征，以及与阿片类药物使用相关的住院率的关系。设计回顾性队列研究。2010年20%医保受益人随机抽样处方药品及医疗索赔数据库的建立。参与者为1 808 355名医疗保险受益人，他们在2010年从药房开具了至少一张阿片类药物处方。从多个提供者处开具阿片类药物处方的受益人比例；这些处方中同时供应的比例；与多个提供者处方相关的阿片类药物使用相关的调整住院率。结果在1 208 100名获得阿片类药物处方的受益人中，418 530人（34.6%）从两家供应商处方，171 420人（14.2%）从三家供应商处方，143 344人（11.9%）从四家及以上供应商处方。在拥有四个或更多阿片类药物提供者的受益人中，110671人（77.2%）同时从多个提供者处获得阿片类药物处方，主要提供者开出的处方不到每位受益人平均总处方的一半（7.9/15.2张处方）。在同时开兴奋剂、非麻醉性镇痛药、中枢神经系统、神经肌肉和抗肿瘤药物的受益人中，多提供者处方最高。与阿片类药物使用相关的住院率随着多个提供者处方的增加而增加：有一个提供者的受益人的年未调整入院率为1.63%(95%置信区间1.58至1.67%)，两个提供者的年未调整入院率为2.08%(2.03%至2.14%)，三个提供者的年未调整入院率为2.87%(2.77%至2.97%)，四个或更多提供者的年未调整入院率为4.83%（4.70%至4.96%）。协变量调整后结果相似。结论：多个提供者同时开具阿片类药物处方在医疗保险患者中很常见，并且与阿片类药物使用相关的住院率较高相关。
Objectives To estimate the frequency and characteristics of opioid prescribing by multiple providers in Medicare and the association with hospital admissions related to opioid use. Design Retrospective cohort study. Setting Database of prescription drugs and medical claims in 20% random sample of Medicare beneficiaries in 2010. Participants 1 808 355 Medicare beneficiaries who filled at least one prescription for an opioid from a pharmacy in 2010. Main outcome measures Proportion of beneficiaries who filled opioid prescriptions from multiple providers; proportion of these prescriptions that were concurrently supplied; adjusted rates of hospital admissions related to opioid use associated with multiple provider prescribing. Results Among 1 208 100 beneficiaries with an opioid prescription, 418 530 (34.6%) filled prescriptions from two providers, 171 420 (14.2%) from three providers, and 143 344 (11.9%) from four or more providers. Among beneficiaries with four or more opioid providers, 110 671 (77.2%) received concurrent opioid prescriptions from multiple providers, and the dominant provider prescribed less than half of the mean total prescriptions per beneficiary (7.9/15.2 prescriptions). Multiple provider prescribing was highest among beneficiaries who were also prescribed stimulants, non-narcotic analgesics, and central nervous system, neuromuscular, and antineoplastic drugs. Hospital admissions related to opioid use increased with multiple provider prescribing: the annual unadjusted rate of admission was 1.63% (95% confidence interval 1.58 to 1.67%) for beneficiaries with one provider, 2.08% (2.03% to 2.14%) for two providers, 2.87% (2.77% to 2.97%) for three providers, and 4.83% (4.70% to 4.96%) for four or more providers. Results were similar after covariate adjustment. Conclusions Concurrent opioid prescribing by multiple providers is common in Medicare patients and is associated with higher rates of hospital admission related to opioid use.