Safety and Distribution of Opioid Prescribing by US Surgeons
Safety and Distribution of Opioid Prescribing by US Surgeons
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DOI：
10.1097/sla.0000000000005802
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发表时间：
2023-06-01
影响因子：
9
通讯作者：
Chua, Kao-Ping
中科院分区：
文献类型：
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作者：
Waljee, Jennifer F.;Gunaseelan, Vidhya;Chua, Kao-Ping
目的：评估美国外科医生阿片类药物处方中的高风险处方模式；描述外科医生中高风险处方的分布特征。背景：缺乏关于美国外科医生阿片类药物处方流行率和高风险阿片类药物处方的全国数据。方法：使用 IQVIA 处方数据库（该数据库报告了 92% 的美国药房配药情况），我们确定了 2019 年外科医生向年龄 >= 12 岁患者配药的阿片类药物处方。 “高风险”处方的特点是：供应天数 >7、每日剂量 >= 50 口服吗啡当量 (OME)、阿片类药物-苯二氮卓类药物重叠以及缓释/长效阿片类药物。我们确定了“大手术量外科医生”（处方数>= 95%的医生）所占的阿片类药物处方、总 OME 和高风险处方的比例。我们使用线性回归来识别与大手术量外科医生相关的特征。结果：在纳入的 15,493,018 份阿片类药物处方中，7,036,481 份（45.4%）属于高风险。在 114,610 名外科医生中，有 5753 名外科医生的处方数处于第 95 个百分位数或以上，2019 年开出的处方数量≥ 520 张。高用量外科医生占阿片类药物处方的 33.5%、占 OME 总数的 52.8% 和高风险处方的 44.2%。在大量的外科医生中，73.9% 是整形外科医生，60.6% 在南方执业。年龄较大、男性、专业、地区以及缺乏与学术机构或卫生系统的联系与高风险处方相关。结论：排名前 5% 的外科医生占阿片类药物处方的 33.5%，占高风险处方的 45.4%。鉴于这些外科医生在高风险处方中的巨大作用，针对这些外科医生的质量改进举措可能会产生最大的成果。
Objective:To estimate high-risk prescribing patterns among opioid prescriptions from U.S. surgeons; to characterize the distribution of high-risk prescribing among surgeons. Background:National data on the prevalence of opioid prescribing and high-risk opioid prescribing by U.S. surgeons are lacking. Methods:Using the IQVIA Prescription Database, which reports dispensing from 92% of U.S. pharmacies, we identified opioid prescriptions from surgeons dispensed in 2019 to patients ages >= 12 years. "High-risk" prescriptions were characterized by: days supplied >7, daily dosage >= 50 oral morphine equivalents (OMEs), opioid-benzodiazepine overlap, and extended-release/long-acting opioid. We determined the proportion of opioid prescriptions, total OMEs, and high-risk prescriptions accounted for by "high-volume surgeons" (those in the >= 95th percentile for prescription counts). We used linear regression to identify characteristics associated with being a high-volume surgeon. Results:Among 15,493,018 opioid prescriptions included, 7,036,481 (45.4%) were high-risk. Among 114,610 surgeons, 5753 were in the 95th percentile or above for prescription count, with >= 520 prescriptions dispensed in 2019. High-volume surgeons accounted for 33.5% of opioid prescriptions, 52.8% of total OMEs, and 44.2% of high-risk prescriptions. Among high-volume surgeons, 73.9% were orthopedic surgeons and 60.6% practiced in the South. Older age, male sex, specialty, region, and lack of affiliation with academic institutions or health systems were correlated with high-risk prescribing. Conclusions:The top 5% of surgeons account for 33.5% of opioid prescriptions and 45.4% of high-risk prescriptions. Quality improvement initiatives targeting these surgeons may have the greatest yield given their outsized role in high-risk prescribing.