Opioid Prescribing by Dentists in the Veterans Health Administration.
Opioid Prescribing by Dentists in the Veterans Health Administration.
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DOI：
10.1016/j.amepre.2022.01.023
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发表时间：
2022-09
影响因子：
5.5
通讯作者：
Gellad, Walid F.
中科院分区：
文献类型：
--
作者：
Suda, Katie J.;Evans, Charlesnika T.;Gibson, Gretchen;Jurasic, M. Marianne;Poggensee, Linda;Gonzalez, Beverly;Hubbard, Colin C.;Vivo, Amanda;Cunningham, Fran E.;McGregor, Jessina C.;Gellad, Walid F.
非阿片类止痛药对口腔疼痛更有效，但数据表明，牙科处方阿片类药物过量。这项研究评估了阿片类药物超过建议的程度和与退伍军人健康管理局牙医过度开阿片类药物有关的特征。这是一项关于2015年至2018年退伍军人牙科就诊的全国性横断面研究。根据国家指南，过量处方被定义为>；120毫克吗啡当量(主要结果)。牙科就诊与患者人口学和医学特征之间的关联通过使用泊松回归和按机构和患者分组的泊松回归建立模型，其中过度开药(定义为120毫克吗啡当量)。二次分析评估了阿片类药物处方和3天的供应量。分析日期为2020年1月至2021年5月。在196,595次就诊中，28.7%的人超过了120毫克吗啡当量。周五就诊和慢性口腔疼痛或药物滥用的人与过量处方的患病率更高相关。与男性、年轻退伍军人和白人退伍军人相比，女性、老年退伍军人以及黑人和拉丁裔退伍军人不太可能被过度开药。与侵入性就诊相比，常规牙科就诊的阿片类药物过量处方发生率更高。阿片类药物的过度处方随着时间的推移而减少。白人退伍军人更有可能接受羟考酮和氢可酮，而黑人和拉丁裔更有可能接受可待因和曲马多。在二次分析中，68.5%的阿片类药物处方超过了3天的供应量。退伍军人健康管理局牙医开出的阿片类药物处方中，近三分之一超过了指导方针。开出更高效力和数量的阿片类药物，特别是在周五和某些人口群体，应该作为牙科阿片类药物管理计划的一部分加以解决。
Non-opioid analgesics are more effective for oral pain, but data suggest that dental prescribing of opioids is excessive. This study evaluates the extent to which opioids exceed recommendations and characteristics associated with opioid overprescribing by Veterans Health Administration dentists. This was a national cross-sectional study of Veterans’ dental visits from 2015 to 2018. Overprescribing was defined per national guidelines as >120 morphine milligram equivalents (primary outcome). The association of dental visit and patient demographic and medical characteristics was modeled with overprescribing (defined as >120 morphine milligram equivalents) using Poisson regression with clustering by facility and patient. A secondary analysis assessed opioid prescriptions >3 days’ supply. The dates of analysis were January 2020 to May 2021. Of the 196,595 visits, 28.7% exceeded 120 morphine milligram equivalents. Friday visits and people with chronic oral pain or substance misuse were associated with a higher prevalence of overprescribing. Women, older, and Black and Latinx Veterans were less likely to be overprescribed than men, younger, and White Veterans. Routine dental visits had a higher prevalence of opioid overprescribing compared with invasive visits. Opioid overprescribing decreased over time. White Veterans were more likely to receive oxycodone and hydrocodone whereas people of Black race and Latinx ethnicity were more likely to receive codeine and tramadol. In the secondary analysis, 68.5% of opioid prescriptions exceeded a 3 days’ supply. Nearly 1 in 3 opioids prescribed by Veterans Health Administration dentists exceed guidelines. Prescribing higher potency and quantities of opioids, especially on Fridays and to certain demographic groups, should be addressed as part of dental opioid stewardship programs.
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CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R
影响因子：
13.8
作者：
Muench J;Fankhauser K;Voss RW;Huguet N;Hartung DM;O'Malley J;Bailey SR;Cowburn S;Wright D;Barker G;Ukhanova M;Chamine I
通讯作者：
Chamine I
DOI：
10.1056/nejmsa2034159
发表时间：
2021-07-22
期刊：
The New England journal of medicine
影响因子：
--
作者：
Morden NE;Chyn D;Wood A;Meara E
通讯作者：
Meara E
影响因子：
33.7
作者：
Dowell, Deborah;Haegerich, Tamara M.;Chou, Roger
通讯作者：
Chou, Roger
影响因子：
3.9
作者：
Koppen, Laura;Suda, Katie J.;Evans, Charlesnika T.
通讯作者：
Evans, Charlesnika T.