Sekhon Ripple, Aminjavahery Noushin, Davis Charles N, Roswarski Mary Jayne, Robinette Camille
W.G. (Bill) Hefner VAMC, Salisbury, North Carolina.
Pain Med. 2013 Oct;14(10):1548-56. doi: 10.1111/pme.12164. Epub 2013 Jun 7.
The primary objective of this study was to measure prescribing compliance with the Veterans Affairs/Department of Defense treatment guidelines for chronic non-cancer pain (CNCP) in the primary care setting. We also determined the proportion of subjects who demonstrated aberrant drug-related behaviors (ADRBs) and the patient characteristics associated with them.
This is a retrospective chart review.
Primary care setting in Veterans Affairs Medical Center.
All patients with CNCP between the ages of 18 and 87 years who received opioid prescriptions for 3 or more consecutive months during a 1-year period (July 2009 to August 2010) were eligible for inclusion. A random sample of 800 patients was selected using pharmacy prescription database. Chi-square test was utilized to analyze associations between ADRB and patient characteristics.
About half the patients in our sample had a signed opioid pain care agreement (OPCA), and at least one urine drug test (UDT) was obtained. UDT was positive for an illicit drug/unreported opioid in 19.5% of the patients, and negative for the prescribed drug in 25.2% of the sample. About 10% of the sample population had morphine equivalent dose equal to or greater than 200 mg/day. ADRBs were identified in 22.9% of the patients. Younger age, psychiatric comorbidities, history of substance abuse, and high opioid dose were associated with high risk of ADRB, but the presence of OPCA lowered the risk of ADRB.
This article studied the prescribing practices of opioids in a primary care setting and can be used to enhance provider education regarding chronic pain guidelines.
本研究的主要目的是衡量在初级保健环境中，对退伍军人事务部/国防部慢性非癌性疼痛（CNCP）治疗指南的处方依从性。我们还确定了表现出异常药物相关行为（ADRB）的受试者比例以及与之相关的患者特征。
这是一项回顾性图表审查。
退伍军人事务医疗中心的初级保健环境。
在1年期间（2009年7月至2010年8月）连续3个月或更长时间接受阿片类药物处方的所有18至87岁的CNCP患者均符合纳入条件。使用药房处方数据库随机抽取800名患者。采用卡方检验分析ADRB与患者特征之间的关联。
我们样本中约一半的患者签署了阿片类药物疼痛护理协议（OPCA），并且至少进行了一次尿液药物检测（UDT）。19.5%的患者UDT检测出非法药物/未报告的阿片类药物呈阳性，25.2%的样本中规定药物检测呈阴性。约10%的样本人群吗啡等效剂量等于或大于200毫克/天。22.9%的患者被确定存在ADRB。年龄较小、有精神疾病共病、有药物滥用史和高阿片类药物剂量与ADRB的高风险相关，但签署OPCA可降低ADRB风险。
本文研究了初级保健环境中阿片类药物的处方实践，可用于加强提供者关于慢性疼痛指南的教育。
