Changes in Opioid Prescribing Patterns Among Generalists and Oncologists for Medicare Part D Beneficiaries From 2013 to 2017
Changes in Opioid Prescribing Patterns Among Generalists and Oncologists for Medicare Part D Beneficiaries From 2013 to 2017
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DOI：
10.1001/jamaoncol.2020.2211
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发表时间：
2020-08-01
期刊：
影响因子：
28.4
通讯作者：
Royce, Trevor J.
中科院分区：
文献类型：
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作者：
Agarwal, Ankit;Roberts, Andrew;Royce, Trevor J.
问题：在阿片类药物在全科医生和肿瘤学家中流行期间，医疗保险患者的阿片类药物处方模式发生了怎样的变化？结果在这项对251 820名全科医生和14 210名肿瘤学家的处方模式进行的横断面研究中，分析了医疗保险D部分处方者文件，在全科医生中，每100名医疗保险受益人的阿片类药物处方年调整平均率从68.2降至49.7（调整后的发病率比= 0.73），2013年至2017年期间，肿瘤学家的发病率比从77.8降至58.8（调整后的发病率比= 0.76）。这意味着肿瘤学家和通才在降低阿片类药物处方率方面有类似的趋势，这引起了人们的担忧，即在阿片类药物流行期间，获得适当的阿片类药物为基础的癌症疼痛管理可能会受到无意中的限制。重要性为了应对阿片类药物流行，旨在减少阿片类药物处方、误用和滥用的政策可能会产生限制获得必要的阿片类药物治疗癌症相关疼痛的意外后果。目前尚不清楚在这个时代，阿片类药物处方模式在全科医生和肿瘤学家中发生了怎样的变化。目的研究2013年至2017年肿瘤学家和全科医生医疗保险D部分受益人的阿片类药物处方率趋势。设计、设置和参与者这项对全科医生（内科、家庭医学、老年医学、全科）和肿瘤学专家（内科肿瘤学、血液肿瘤学和放射肿瘤学）的重复横断面研究分析了2013年至2017年的医疗保险提供者利用和支付数据：D部分处方者文件。全科医生与肿瘤专科医生的风险暴露。主要结果和测量结果包括每100名Medicare Part D受益人的阿片类药物和长效阿片类药物处方的医生水平比率。Poisson回归用于估计年度预测结局率和发病率比，调整处方者特征和状态固定效应。结果分析了251.820名全科医生和14.210名肿瘤科医生的处方模式。从2013年到2017年，每100名医疗保险受益人的阿片类药物处方的年度调整预测平均率从68.2下降到49.7（调整后的发病率比[aIRR] = 0.73; 95% CI，0.73-0.73），肿瘤学家中从77.8降至58.8（aIRR = 0.76; 95% CI，0.74-0.77）。每100名医疗保险受益人的长效阿片类药物处方率也从8.0下降到5.4（aIRR = 0.67; 95%CI，0.66-0.68），肿瘤学家从18.6下降到13.3（aIRR = 0.72; 95%CI，0.69-0.74）。结论和相关性我们发现，从2013年到2017年，全科医生和肿瘤学家对医疗保险受益人的阿片类药物处方率大幅下降。阿片类药物政策和宣传似乎有效地减少了医疗保险人群中阿片类药物处方的程度。全科医生和肿瘤学家之间的类似下降引起了人们的担忧，即癌症疼痛管理可能无意中受到限制。肿瘤学家处方的减少有多少是适当的与不适当的值得进一步调查。这项横断面研究分析了医疗保险D部分处方者文件，以确定2013年至2017年阿片类药物流行期间肿瘤学家和通才之间阿片类药物处方模式的变化。
Question How have opioid prescribing patterns for Medicare patients changed during the opioid epidemic among generalists and oncologists? Findings In this cross-sectional study of the prescribing patterns of 251 820 generalists and 14 210 oncologists, analyzing Medicare Part D prescriber files, the annual adjusted mean rate of opioid prescriptions per 100 Medicare beneficiaries decreased from 68.2 to 49.7 among generalists (adjusted incidence rate ratio = 0.73) and from 77.8 to 58.8 among oncologists (adjusted incidence rate ratio = 0.76) between 2013 and 2017. Meaning Oncologists and generalists had similar trends in decreasing opioid prescription rates, raising concern that access to appropriate opioid-based cancer pain management may be inadvertently restricted during the opioid epidemic.Importance In response to the opioid epidemic, policies aiming to reduce opioid prescribing, misuse, and abuse may have the unintended consequence of restricting access to necessary opioid therapy for cancer-related pain. It is unknown how opioid prescribing patterns have changed among generalists and oncologists during this era. Objective To examine trends in opioid prescription rates for Medicare Part D beneficiaries from 2013 to 2017 among oncologists and generalists. Design, Setting, and Participants This repeated cross-sectional study of generalist physicians (internal medicine, family medicine, geriatric medicine, general practice) and oncology specialists (medical oncology, hematology-oncology, and radiation oncology) analyzed the Medicare Provider Utilization and Payment Data: Part D prescriber files from 2013 to 2017. Exposures Generalist vs oncology specialty. Main Outcomes and Measures Outcomes included physician-level rates of both opioid and long-acting opioid prescriptions per 100 Medicare Part D beneficiaries. Poisson regression was used to estimate annual predicted outcome rates and incidence rate ratios, adjusting for prescriber characteristics and state fixed effects. Results We analyzed the prescribing patterns of 251.820 generalists and 14.210 oncologists. From 2013 to 2017, the annual adjusted predicted mean rate of opioid prescriptions per 100 Medicare beneficiaries decreased from 68.2 to 49.7 among generalists (adjusted incidence rate ratio [aIRR] = 0.73; 95% CI, 0.73-0.73) and from 77.8 to 58.8 among oncologists (aIRR = 0.76; 95% CI, 0.74-0.77). The rate of long-acting opioid prescriptions per 100 Medicare beneficiaries also decreased from 8.0 to 5.4 for generalists (aIRR = 0.67; 95% CI, 0.66-0.68) and from 18.6 to 13.3 for oncologists (aIRR = 0.72; 95% CI, 0.69-0.74). Conclusions and Relevance We found large declines in opioid prescription rates for Medicare beneficiaries by generalists and oncologists from 2013 to 2017. Opioid policy and advocacy appear to have been effective in reducing the extent of opioid prescribing in the Medicare population. Similar declines between generalists and oncologists raise concern that access to cancer pain management may have been inadvertently restricted. How much of the decrease in prescribing by oncologists is appropriate vs inappropriate deserves further investigation.This cross-sectional study analyzed Medicare Part D prescriber files to determine changes in opioid prescribing patterns among oncologists and generalists between 2013 and 2017, during the opioid epidemic.