Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines
Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines
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DOI：
10.1007/s11606-015-3470-8
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发表时间：
2016-02-01
影响因子：
5.7
通讯作者：
Mandl, Kenneth D.
中科院分区：
文献类型：
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作者：
Ong, Mei-Sing;Olson, Karen L.;Mandl, Kenneth D.
背景：在美国，处方苯二氮卓类药物过量继续导致显著的发病率和死亡率。目的：利用社会网络分析，阐明提供者职业关系对多提供者开苯二氮卓类药物处方的影响。设计：对2008至2011年间的商业保健索赔进行回顾分析。使用社交网络分析对提供者患者共享网络进行建模。护理团队凝聚力是使用护理密度来衡量的，护理密度定义为患者护理团队内提供者对共享的患者总数与护理团队中提供者对总数之间的比率。使用一系列网络指标进一步量化提供商对之间的关系，包括共享患者或合作者的数量和比例。主要指标：患者共享网络指标与多次开苯二氮卓类药物的可能性之间的关系。伙伴：年龄在18岁到岁之间的患者从多个提供商那里获得两张或两张以上的苯二氮卓类药物处方，重叠覆盖时间超过14天。结果：共有5659名患者和1448名提供商对患者纳入我们的研究。其中，1028名患者(18.2%)接受了苯二氮卓类药物的多次处方，涉及445对提供者(30.7%)。很少与患者共用药物提供者的患者得到重叠苯二氮类药物处方的风险更高；开了重叠苯二氮类药物的患者的中位护理密度为8.1，而未开重叠苯二氮类药物的患者的中位护理密度为10.1(P
BACKGROUND: Prescription benzodiazepine overdose continues to cause significant morbidity and mortality in the US. Multiple-provider prescribing, due to either fragmented care or "doctor-shopping," contributes to the problem.OBJECTIVE: To elucidate the effect of provider professional relationships on multiple-provider prescribing of benzodiazepines, using social network analytics.DESIGN: A retrospective analysis of commercial healthcare claims spanning the years 2008 through 2011. Provider patient-sharing networks were modelled using social network analytics. Care team cohesion was measured using care density, defined as the ratio between the total number of patients shared by provider pairs within a patient's care team and the total number of provider pairs in the care team. Relationships within provider pairs were further quantified using a range of network metrics, including the number and proportion of patients or collaborators shared.MAIN MEASURES: The relationship between patient-sharing network metrics and the likelihood of multiple prescribing of benzodiazepines.PARTICIPANTS: Patients between the ages of 18 and 64 years who received two or more benzodiazepine prescriptions from multiple providers, with overlapping coverage of more than 14 days.RESULTS: A total of 5659 patients and 1448 provider pairs were included in our study. Among these, 1028 patients (18.2 %) received multiple prescriptions of benzodiazepines, involving 445 provider pairs (30.7 %). Patients whose providers rarely shared patients had a higher risk of being prescribed overlapping benzodiazepines; the median care density was 8.1 for patients who were prescribed overlapping benzodiazepines and 10.1 for those who were not (p