Smulowitz Peter B, Cary Chris, Boyle Katherine L, Novack Victor, Jagminas Liudvikas
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Intern Emerg Med. 2016 Dec;11(8):1121-1124. doi: 10.1007/s11739-016-1505-8. Epub 2016 Jul 16.
Abuse of opioid prescription drugs has become an epidemic across the developed world. Despite the fact that emergency physicians overall account for a small proportion of total opioids prescribed, the number of prescriptions has risen dramatically in the past decade and, to some degree, contributes to the available supply of opioids in the community, some of which are diverted for non-medical use. Since successfully reducing opioid prescribing on the individual level first requires knowledge of current prescribing patterns, we sought to determine to what extent variation exists in opioid prescribing patterns at our institution. This was a single-institution observational study at a community hospital with an annual ED volume of 47,000 visits. We determined the number of prescriptions written by each provider, both total number and accounting for the number of patients seen. Our primary outcome measure was the level of variation at the physician level for number of prescriptions written per patient. We also identified the mean number of pills written per prescription. We analyzed data from November 13, 2014 through July 31, 2015 for 21 full-time providers. There were a total of 2211 prescriptions for opioids written over this time period for a total of 17,382 patients seen. On a per-patient basis, the rate of opioid prescriptions written per patient during this period was 127 per 1000 visits (95 % CI 122-132). There was a variation on the individual provider level, with rates ranging from 33 per to 332 per 1000 visits. There was also substantial variation by provider in the number of pills written per prescription with coefficient of variation (standard deviation divided by mean) averaged over different opioids ranging from 16 to 40 %. There was significant variation in opioid prescribing patterns at the individual physician level, even when accounting for the number of patients seen.
阿片类处方药的滥用在整个发达国家已成为一种流行病。尽管急诊医生开具的阿片类药物总量在所有开具的阿片类药物中占比很小，但在过去十年中，处方数量急剧上升，并且在一定程度上导致了社区中阿片类药物的供应，其中一些被转用于非医疗用途。由于首先在个体层面成功减少阿片类药物的处方需要了解当前的处方模式，我们试图确定我们机构的阿片类药物处方模式存在多大程度的差异。这是一项在一家社区医院进行的单机构观察性研究，该医院急诊科每年就诊量为47000人次。我们确定了每位医生开具的处方数量，包括总数以及按就诊患者数量计算的数量。我们的主要结局指标是每位患者开具的处方数量在医生层面的差异程度。我们还确定了每张处方开具的平均药丸数量。我们分析了2014年11月13日至2015年7月31日期间21名全职医生的数据。在此期间，共开具了2211份阿片类药物处方，涉及的就诊患者总数为17382人。在此期间，每位患者的阿片类药物处方率为每1000次就诊127份（95%置信区间122 - 132）。在个体医生层面存在差异，比率范围为每1000次就诊33份至332份。每位医生每张处方开具的药丸数量也存在很大差异，不同阿片类药物的变异系数（标准差除以均值）平均在16%至40%之间。即使考虑到就诊患者数量，个体医生层面的阿片类药物处方模式仍存在显著差异。
