Weiner Scott G, Griggs Christopher A, Langlois Breanne K, Mitchell Patricia M, Nelson Kerrie P, Friedman Franklin D, Feldman James A
Department of Emergency Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina.
J Emerg Med. 2015 Apr;48(4):424-31.e1. doi: 10.1016/j.jemermed.2014.11.008. Epub 2015 Jan 28.
There is a need to accurately identify patients at risk for drug abuse before giving a prescription for a scheduled medication.
Our aim was to describe a subset of emergency department (ED) patients that had eight or more schedule II-V prescriptions filled from eight or more providers in 1 year, known as "doctor-shopping" (DS) behavior, to compare demographic features of DS and non-DS patients, and to determine clinical factors associated with DS.
We conducted a prospective, observational study of emergency providers' (EPs) assessment of patients with back pain, dental pain, or headache. EPs recorded patient demographics, clinical characteristics, and numbers of schedule II-V prescriptions, subset opioid prescriptions, providers, and pharmacies utilized in a 12-month period, as reported on the state prescription drug-monitoring program. χ(2) and t-tests were used to compare DS with non-DS patients on demographics; a multivariate logistic regression was performed to determine clinical factors associated with DS.
Five hundred and forty-four patient visits were recorded; 12.3% (n = 67) had DS behavior. DS and non-DS patients were similar in sex but differed in age, race, chief complaint, and weekday vs. weekend arrival. DS patients utilized a median of 12.0 (interquartile range [IQR] 9.0-18.0) providers compared with a median of 1.0 (IQR 0-2.0) providers in the non-DS group. Reporting allergies to non-narcotic medications (odds ratio [OR] = 3.1; 95% confidence interval [CI] 1.4-6.9; p = 0.01), requesting medications by name (OR = 2.7; 95% CI 1.5-4.9; p < 0.01), and hospital site (OR = 2.0; 95% CI 1.1-3.6; p = 0.03) were significantly associated with DS.
There are multiple clinical characteristics associated with DS in this patient population.
在为受管制药物开处方之前，有必要准确识别有药物滥用风险的患者。
我们的目的是描述急诊科（ED）中一部分在1年内从8个或更多提供者处开具8张或更多II-V类管制药品处方的患者，即所谓的“找医生开药”（DS）行为，比较DS患者和非DS患者的人口统计学特征，并确定与DS相关的临床因素。
我们对急诊科医生（EP）对背痛、牙痛或头痛患者的评估进行了一项前瞻性观察研究。EP记录了患者的人口统计学信息、临床特征以及II-V类管制药品处方数量、阿片类药物处方子集、提供者以及在12个月期间使用的药房，这些信息来自州处方药监测计划。使用χ²检验和t检验比较DS患者和非DS患者的人口统计学特征；进行多因素逻辑回归以确定与DS相关的临床因素。
记录了544例患者就诊情况；12.3%（n = 67）有DS行为。DS患者和非DS患者在性别上相似，但在年龄、种族、主要症状以及工作日与周末就诊方面存在差异。DS患者使用的提供者中位数为12.0（四分位间距[IQR]9.0 - 最终答案：18.0），而非DS组为1.0（IQR 0 - 2.0）。报告对非麻醉药物过敏（比值比[OR]=3.1；95%置信区间[CI]1.4 - 6.9；p = 0.01）、按名称要求开药（OR = 2.7；95% CI 1.5 - 4.9；p < 0.01）以及医院地点（OR = 2.0；95% CI 1.1 - 3.6；p = 0.03）与DS显著相关。
在这一患者群体中，有多种与DS相关的临床特征。
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