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医疗补助计划中患有阿片类药物使用障碍的参保者的阿片类镇痛剂和苯二氮䓬类药物处方:医疗服务提供者群体的影响

Opioid analgesic and benzodiazepine prescribing among Medicaid-enrollees with opioid use disorders: The influence of provider communities.

作者信息

Stein Bradley D, Mendelsohn Joshua, Gordon Adam J, Dick Andrew W, Burns Rachel M, Sorbero Mark, Shih Regina A, Liccardo Pacula Rosalie

机构信息

a RAND Corporation , Pittsburgh , Pennsylvania , USA.

b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.

出版信息

J Addict Dis. 2017 Jan-Mar;36(1):14-22. doi: 10.1080/10550887.2016.1211784. Epub 2016 Jul 22.


DOI:10.1080/10550887.2016.1211784
PMID:27449904
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5366980/
Abstract

Opioid analgesic and benzodiazepine use in individuals with opioid use disorders can increase the risk for medical consequences and relapse. Little is known about rates of use of these medications or prescribing patterns among communities of prescribers. The goal of this study was to examine rates of prescribing to Medicaid-enrollees in the calendar year after an opioid use disorder diagnosis, and to examine individual, county, and provider community factors associated with such prescribing. 2008 Medicaid claims data were used from 12 states to identify enrollees diagnosed with opioid use disorders, and 2009 claims data were used to identify rates of prescribing of each drug. Social network analysis was used to identify provider communities, and multivariate regression analyses was used to to identify patient, county, and provider community level factors associated with prescribing these drugs. The authors also examined variation in rates of prescribing across provider communities. Among Medicaid-enrollees identified with an opioid use disorder, 45% filled a prescription for an opioid analgesic, 37% filled a prescription for a benzodiazepine, and 21% filled a prescription for both in the year following their diagnosis. Females, older individuals, individuals with pain syndromes, and individuals residing in counties with higher rates of poverty were more likely to fill prescriptions. Prescribing rates varied substantially across provider communities, with rates in the highest quartile of prescribing communities over 2.5 times the rates in the lowest prescribing communities. Prescribing opioid analgesics and benzodiazepines to individuals diagnosed with opioid use disorders may increase risk of relapse and overdose. Interventions should be considered that target provider communities with the highest rates of prescribing and individuals at the highest risk.

摘要

在患有阿片类药物使用障碍的个体中使用阿片类镇痛药和苯二氮䓬类药物会增加出现医学后果和复发的风险。对于这些药物的使用频率或开处方模式在开处方者群体中情况如何,人们知之甚少。本研究的目的是调查在阿片类药物使用障碍诊断后的日历年中,医疗补助参保者的处方开具率,并研究与这种处方开具相关的个体、县和医疗服务提供者群体因素。利用来自12个州的2008年医疗补助报销数据来识别被诊断患有阿片类药物使用障碍的参保者,并用2009年的报销数据来确定每种药物的处方开具率。使用社会网络分析来识别医疗服务提供者群体,并用多元回归分析来识别与这些药物处方开具相关的患者、县和医疗服务提供者群体层面的因素。作者还研究了不同医疗服务提供者群体之间处方开具率的差异。在被确定患有阿片类药物使用障碍的医疗补助参保者中,45% 的人开具了阿片类镇痛药处方,37% 的人开具了苯二氮䓬类药物处方,21% 的人在诊断后的一年内同时开具了这两种药物的处方。女性、年龄较大者、患有疼痛综合征的个体以及居住在贫困率较高县的个体更有可能开具处方。不同医疗服务提供者群体之间的处方开具率差异很大,处方开具率最高的四分位数群体的开具率是最低开具率群体的2.5倍以上。给被诊断患有阿片类药物使用障碍的个体开具阿片类镇痛药和苯二氮䓬类药物可能会增加复发和过量用药的风险。应考虑针对处方开具率最高的医疗服务提供者群体以及风险最高的个体采取干预措施。

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[6]
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[7]
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