Trajectories of prescription opioids filled over time
Trajectories of prescription opioids filled over time
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DOI：
10.1371/journal.pone.0222677
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发表时间：
2019-10-04
期刊：
影响因子：
3.7
通讯作者：
Nagin, Daniel
中科院分区：
文献类型：
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作者：
Elmer, Jonathan;Fogliato, Riccardo;Nagin, Daniel
我们进行了一项回顾性队列研究，旨在确定一个或多个遵循慢性高处方使用模式的群体，并量化个体属于高利用者群体的时间依赖性概率。我们分析了2009-2017年在宾夕法尼亚州阿勒格尼县参加医疗补助的52，456名18-45岁成年人的数据，他们至少填写了一份阿片类镇痛药处方。我们使用基于组的轨迹建模来识别随着时间的推移具有不同处方阿片类药物使用模式的个体组。我们发现人口是由三个不同的轨迹组。第一组包括83%的人口，在他们的索引处方后，填写了很少的阿片类药物处方。第二组（12%）最初平均每月开一次处方，但两年后下降到接近零。第三组（6%）表现出持续的高阿片类药物处方利用率。利用个体患者加入高利用组的后验概率（随着新信息的可用，该概率可以随着时间的推移迭代更新），我们定义了预测未来持续阿片类药物使用的敏感阈值。我们的结论是，从有限的观察数据中，可以在临床病程的早期识别出持续使用阿片类药物的风险个体。
We performed a retrospective cohort study that aimed to identify one or more groups that followed a pattern of chronic, high prescription use and quantify individuals' time-dependent probabilities of belonging to a high-utilizer group. We analyzed data from 52,456 adults age 18-45 who enrolled in Medicaid from 2009-2017 in Allegheny County, Pennsylvania who filled at least one prescription for an opioid analgesic. We used group-based trajectory modeling to identify groups of individuals with distinct patterns of prescription opioid use over time. We found the population to be comprised of three distinct trajectory groups. The first group comprised 83% of the population and filled few, if any, opioid prescriptions after their index prescription. The second group (12%) initially filled an average of one prescription per month, but declined over two years to near-zero. The third group (6%) demonstrated sustained high opioid prescriptions utilization. Using individual patients' posterior probability of membership in the high utilization group, which can be updated iteratively over time as new information become available, we defined a sensitive threshold predictive of sustained future opioid utilization. We conclude that individuals at risk of sustained opioid utilization can be identified early in their clinical course from limited observational data.