Inappropriate prescribing of opioids for patients undergoing surgery.
Inappropriate prescribing of opioids for patients undergoing surgery.
复制标题
为接受手术的患者开具阿片类药物的不当处方。
DOI：
10.1073/pnas.2210226119
复制
发表时间：
2022-12-06
影响因子：
11.1
通讯作者：
中科院分区：
文献类型：
--
作者：
由于与阿片类药物使用相关的安全风险，医生的阿片类药物处方受到监管。安全处方的一个重要组成部分是，处方应该只给打算使用处方药物的患者开。在商业保险人群中，我们检查了门诊手术患者配偶的阿片类药物处方。由于患者可能无法在手术后自行配药，外科医生可能会不恰当地给患者的配偶开阿片类药物。在未自行填写围手术期阿片类药物处方的患者中，手术当天配偶处方阿片类药物填充率明显高于周围几周的配偶处方阿片类药物填充率，这表明患者故意向患者配偶开具临床上不适当的阿片类药物处方。为了应对美国阿片类药物的流行，各州通过了旨在规范医生如何开阿片类药物处方的政策。然而，为了使这些政策有效，阿片类药物必须开给它们的目标患者。阿片类药物处方是否为那些不打算服用它们的人开的，从经验上很难证明。在一个有商业保险的人群中，我们检查了在患者手术当天由接受门诊手术的患者的配偶开具和填写的阿片类药物处方，并将其与周围的日子进行了比较。由于患者可能无法在手术后立即自行配药，外科医生可能会给患者的配偶开阿片类药物，这在临床上是不合适的。在研究的450125对opioid-naïve夫妇中，对于自己没有填写围手术期阿片类药物处方的患者，在手术当天（DOS）的配偶填充率为每1000例手术2.39次填充，而其他围手术期的配偶填充率为0.44次（调整优势比（aOR）， 5.5, 95% CI, 4.6-6.5）。对于自己服用阿片类药物处方的患者，配偶服用阿片类药物的情况没有增加。这些发现表明阿片类药物处方是故意的，临床上不适当的。
Opioid prescribing by physicians is regulated due to safety risks associated with opioid use. An important component of safe prescribing is that prescriptions should only be written for patients who are intended to use the prescribed medication. In a commercially insured population, we examined opioid prescribing to spouses of patients undergoing outpatient surgery. Because patients may be unable to fill prescriptions themselves after surgery, surgeons may inappropriately prescribe opioids to a patient’s spouse. Among patients who did not fill perioperative opioid prescriptions themselves, the rate of spousal prescription opioid fills on the day of surgery was significantly higher compared with spousal opioid fills in surrounding weeks, suggesting intentional, clinically inappropriate prescribing of opioids to patients’ spouses. In response to the opioid epidemic in the United States, states have passed policies aimed at regulating how opioids are prescribed by physicians. For such policies to be effective, however, opioids must be prescribed to the patients for whom they are intended. Whether opioid prescriptions are written for those who are not intended to consume them is empirically difficult to show. In a commercially insured population, we examined opioid prescriptions written for and filled by spouses of patients undergoing outpatient surgery on the day of a patient’s surgery compared with the surrounding days. Because patients may be unable to fill prescriptions themselves immediately after surgery, surgeons may prescribe opioids to a patient’s spouse, which would be clinically inappropriate. Among 450,125 opioid-naïve couples studied, for patients who did not fill perioperative opioid prescriptions themselves, the rate of spousal fills on the day of surgery (DOS) was 2.39 fills per 1,000 surgeries compared with 0.44 fills on all other perioperative days (adjusted odds ratio (aOR), 5.5, 95% CI, 4.6–6.5). Increases in spousal opioid fills were not present for patients that filled opioid prescriptions themselves. These findings suggest intentional, clinically inappropriate prescribing of opioids.
登录
查看更多内容
DOI：
10.1377/hlthaff.2020.01762
发表时间：
2021-06
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Worsham CM;Woo J;Jena AB;Barnett ML
通讯作者：
Barnett ML
影响因子：
39
作者：
Seamans, Marissa J.;Carey, Timothy S.;Brookhart, M. Alan
通讯作者：
Brookhart, M. Alan
影响因子：
9
作者：
Hill, Maureen V.;McMahon, Michelle L.;Barth, Richard J. Jr
通讯作者：
Barth, Richard J. Jr
影响因子：
16.9
作者：
Harbaugh, Calista M.;Lee, Jay S.;Waljee, Jennifer F.
通讯作者：
Waljee, Jennifer F.
影响因子：
5.3
作者：
Varady, Nathan H.;Smith, Eric L.;Chen, Antonia F.
通讯作者：
Chen, Antonia F.