Olsen Yngvild, Daumit Gail L, Ford Daniel E
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Bloomberg School of Public Health, Baltimore, Maryland 21287, USA.
J Pain. 2006 Apr;7(4):225-35. doi: 10.1016/j.jpain.2005.11.006.
Little is known about primary care physicians' (PCPs) prescribing of opioids. We describe trends and factors associated with opioid prescribing during PCP visits over the past decade. Using the National Ambulatory Medical Care Survey, we found an opioid prescribed in 2,206 (5%) PCP visits from 1992 to 2001. The prevalence of visits where an opioid was prescribed increased from a low of 41 per 1000 visits in 1992-1993 to a peak of 63 per 1000 in 1998-1999 (P < .0001 for trend) and then stabilized (59 per 1000 in 2000-2001). Several factors increased the odds of receiving an opioid: having Medicaid (odds ratio [OR] 2.09 [95% confidence interval (CI) 1.82-2.40]) or Medicare (OR 2.00 [95% CI 1.68-2.39]); having a visit between 15 and 35 minutes (OR 1.16 [95% CI 1.05-1.27]); and receiving an NSAID (OR 2.27 [95% CI 2.04-2.53]). Patients of hispanic (OR .67 [95% CI .56-.81]) or other race/ethnicity (OR .68 [95% CI .52-.90]), patients in health maintenance organizations (OR .74 [95% CI .66-.84]), and those living in the northeast (OR .60 [95% CI .51-.69]) or midwest (OR .75 [95% CI .66-.85]) had lower odds of receiving an opioid. Substantial variation exists in opioid prescribing by PCPs. Now that pain management standards are advocated, understanding the dynamics of opioid prescribing is necessary.
This study describes a decade-long increase in opioid prescribing by U.S. primary care physicians and identifies important geographic-, racial/ethnic-, and insurance-related differences in who receives these medications. Several underlying factors, including regulatory and legal pressures, attitudes and knowledge of opioids, and publicized opioid-related events, may contribute to these differences.
关于初级保健医生开具阿片类药物的情况，我们知之甚少。我们描述了过去十年中初级保健医生诊疗期间开具阿片类药物的趋势及相关因素。利用国家门诊医疗调查，我们发现在1992年至2001年期间，2206次（5%）初级保健医生诊疗中有阿片类药物被开具。开具阿片类药物的诊疗比例从1992 - 1993年每1000次诊疗中41次的低点，上升至1998 - 1999年每1000次诊疗中63次的峰值（趋势P <.0001），然后趋于稳定（2000 - 2001年为每1000次诊疗中59次）。几个因素增加了开具阿片类药物的几率：拥有医疗补助（比值比[OR] 2.09 [95%置信区间（CI）1.82 - 2.40]）或医疗保险（OR 2.00 [95% CI 1.68 - 2.39]）；诊疗时间在15至35分钟之间（OR 1.16 [95% CI 1.05 - 1.27]）；以及接受非甾体抗炎药（OR 2.27 [95% CI 2.04 - 2.53]）。西班牙裔患者（OR.67 [95% CI.56 -.81]）或其他种族/族裔患者（OR.68 [95% CI.52 -.90]）、健康维护组织中的患者（OR.74 [95% CI.66 -.84]）以及居住在东北部（OR.60 [95% CI.51 -.69]）或中西部（OR.75 [95% CI.66 -.85]）的患者开具阿片类药物的几率较低。初级保健医生在开具阿片类药物方面存在很大差异。既然倡导疼痛管理标准，了解阿片类药物开具的动态情况就很有必要。
本研究描述了美国初级保健医生开具阿片类药物长达十年的增长情况，并确定了在接受这些药物治疗的患者中，与地理、种族/族裔和保险相关的重要差异。包括监管和法律压力、对阿片类药物的态度和知识以及公开的阿片类药物相关事件等几个潜在因素，可能导致了这些差异。
