Rates of Physician Coprescribing of Opioids and Benzodiazepines After the Release of the Centers for Disease Control and Prevention Guidelines in 2016
Rates of Physician Coprescribing of Opioids and Benzodiazepines After the Release of the Centers for Disease Control and Prevention Guidelines in 2016
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DOI：
10.1001/jamanetworkopen.2019.8325
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发表时间：
2019-08-01
影响因子：
13.8
通讯作者：
Karaca-Mandic, Pinar
中科院分区：
文献类型：
--
作者：
Jeffery, Molly M.;Hooten, W. Michael;Karaca-Mandic, Pinar
重要性2016年疾病控制和预防中心指南建议避免同时使用阿片类药物和苯二氮卓类药物。目的确定指南的发布是否与阿片类药物和苯二氮卓类药物的共同处方变化相关。设计，设置，这项回顾性队列研究使用了从美国国家医疗和药房索赔数据库中获得的3598322名成年人的索赔数据。2014年1月1日至3月31日，在研究期间使用处方阿片类药物的商业保险患者和1 299 142名最近没有癌症、镰状细胞病或临终关怀病史的医疗保险优势（MA）受益人，2018.暴露重叠的阿片类药物和苯二氮卓类药物处方填充。主要结果和措施的程度（阿片类药物和苯二氮卓类药物处方重叠天数的人月比例）和强度共处方率（在苯二氮卓类药物也可用的情况下使用阿片类药物的天数比例）。（阿片类药物使用1340万人月），单独商业保险个人总数为3598322人（1 974 731名妇女[54.9%]），唯一的千年生态系统津贴受益人总数为1 299 142人（770 256名妇女[59.3%]）。在128576名经历慢性疼痛发作的参与者中，超过一半的长期阿片类药物使用人月发生在女性中（在有商业保险的人中占52.7%，在CIMMA受益人中占62.4%）。商业保险组患者的中位（四分位距）年龄为51（41-58）岁，MA组患者为70（61-77）岁。商业保险组的平均（SE）共描述程度为23.0%（0.18%），MA组为25.7%（0.18%）。在指南发布后，目标指南人群（长期使用阿片类药物的个体）的共描述程度降低（指南后斜率，商业保险组为每年-0.95个百分点[95%CI，每年-1.44至-0.46个百分点]，商业保险组为每年-1.06个百分点[95%CI，每年-1.49至-0.63个百分点]）。阿片类药物使用的非靶向短期发作与趋势无变化或小幅下降相关（对于MA组，指南后斜率为每年0.47个百分点[95% CI，每年0.35-0.59个百分点];对于商业保险组，指南后斜率为每年-0.05个百分点[95% CI，每年-0.12至0.02个百分点]）。观察到高共处方强度，商业保险组中79.3%（95% CI，78.9%-79.6%）的阿片类处方日和MA组中83.9%（95% CI，83.7%-84.2%）的阿片类处方日与苯二氮卓类药物重叠。共记录的强度没有变化。当同一临床医生处方阿片类药物和benzodiazepines.CONCLUSION和RELEVANCE本研究观察到的程度减少，但不与长期使用阿片类药物的患者的benzodiazepines coprecribing强度较高。
IMPORTANCE The Centers for Disease Control and Prevention guidelines in 2016 recommended avoiding concurrent use of opioids and benzodiazepines.OBJECTIVE To determine whether the release of the guidelines was associated with changes in coprescription of opioids and benzodiazepines.DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used claims data obtained from a US national database of medical and pharmacy claims for 3 598 322 adult commercially insured patients and 1 299 142 Medicare Advantage (MA) beneficiaries with no recent history of cancer, sickle cell disease, or hospice care who ever used prescribed opioids during the study period, January 1, 2014, through March 31, 2018.EXPOSURES Overlapping opioid and benzodiazepine prescriptions filled.MAIN OUTCOMES AND MEASURES The extent (proportion of person-months with any overlapping days of prescription of opioids and benzodiazepines) and intensity (proportion of days with opioids prescribed where benzodiazepines were also available) of coprescription.RESULTS Of 4 897 464 patients (with 13.4 million person-months of opioid use), the total number of unique commercially insured individuals was 3 598 322 (1 974 731 women [54.9%]), and the total number of unique MA beneficiaries was 1 299 142 (770 256 women [59.3%]). Among 128 576 participants experiencing chronic pain episodes, more than one-half of person-months of long-term opioid use occurred in women (52.7% of person-months among those with commercial insurance and 62.4% of person-months amongMA beneficiaries). The median (interquartile range) age of the participants was 51 (41-58) years for patients in the commercial insurance group and 70 (61-77) years for those in the MA group. The mean (SE) extent of coprescription was 23.0% (0.18%) for the commercial insurance group and 25.7%(0.18%) for the MA group. The extent of coprescription decreased in the targeted guideline population-individuals with long-term opioid use-after the guideline release (postguideline slope, -0.95 percentages point per year [95% CI, -1.44 to -0.46 percentage points per year] for the commercial insurance group and-1.06 percentage points per year [95% CI, -1.49 to -0.63 percentage points per year] for the MA group). Nontargeted short-term episodes of opioid use were associated with no change or small declines in trend (for the MA group, postguideline slope of 0.47 percentage point per year [95% CI, 0.35-0.59 percentage point per year]; for the commercial insurance group, postguideline slope of-0.05 percentage point per year [95% CI, -0.12 to 0.02 percentage point per year]). High coprescribing intensity was seen, with 79.3% (95% CI, 78.9%-79.6%) of opioid prescription days in the commercial insurance group and 83.9% (95% CI, 83.7%-84.2%) in the MA group overlapping with benzodiazepines. There was no change in the intensity of coprescribing. Intensity of coprescription was higher when the same clinician prescribed opioids and benzodiazepines.CONCLUSION AND RELEVANCE This study observed a reduction in the extent but not intensity of coprescribing of benzodiazepines for patients with long-term opioid use.