Weiner Scott G, Baker Olesya, Poon Sabrina J, Rodgers Ann F, Garner Chad, Nelson Lewis S, Schuur Jeremiah D
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
Ann Emerg Med. 2017 Dec;70(6):799-808.e1. doi: 10.1016/j.annemergmed.2017.03.057. Epub 2017 May 23.
The objective of our study is to evaluate the association between Ohio's April 2012 emergency physician guidelines aimed at reducing inappropriate opioid prescribing and the number and type of opioid prescriptions dispensed by emergency physicians.
We used Ohio's prescription drug monitoring program data from January 1, 2010, to December 31, 2014, and included the 5 most commonly prescribed opioids (hydrocodone, oxycodone, tramadol, codeine, and hydromorphone). The primary outcome was the monthly statewide prescription total of opioids written by emergency physicians in Ohio. We used an interrupted time series analysis to compare pre- and postguideline level and trend in number of opioid prescriptions dispensed by emergency physicians per month, number of prescriptions stratified by 5 commonly prescribed opioids, and number of prescriptions for greater than 3 days' supply of opioids.
Beginning in January 2010, the number of prescriptions dispensed by all emergency physicians in Ohio decreased by 0.3% per month (95% confidence interval [CI] -0.49% to -0.15%). The implementation of the guidelines in April 2012 was associated with a 12% reduction (95% CI -17.7% to -6.3%) in the level of statewide total prescriptions per month and an additional decline of 0.9% (95% CI -1.1% to -0.7%) in trend relative to the preguideline trend. The estimated effect of the guidelines on total monthly prescriptions greater than a 3-day supply was an 11.2% reduction in level (95% CI -18.8% to -3.6%) and an additional 0.9% (95% CI -1.3% to -0.5%) decline in trend per month after the guidelines. Guidelines were also associated with a reduction in prescribing for each of the 5 individual opioids, with various effect.
In Ohio, emergency physician opioid prescribing guidelines were associated with a decrease in the quantity of opioid prescriptions written by emergency physicians. Although introduction of the guidelines occurred in parallel with other opioid-related interventions, our findings suggest an additional effect of the guidelines on prescribing behavior. Similar guidelines may have the potential to reduce opioid prescribing in other geographic areas and for other specialties as well.
我们研究的目的是评估俄亥俄州2012年4月旨在减少不适当阿片类药物处方的急诊医生指南与急诊医生开具的阿片类药物处方数量及类型之间的关联。
我们使用了俄亥俄州2010年1月1日至2014年12月31日的处方药监测项目数据，纳入了5种最常开具的阿片类药物（氢可酮、羟考酮、曲马多、可待因和氢吗啡酮）。主要结局是俄亥俄州急诊医生每月开具的阿片类药物的全州处方总量。我们采用中断时间序列分析来比较指南前后急诊医生每月开具的阿片类药物处方数量、按5种常用阿片类药物分层的处方数量以及超过3天用量的阿片类药物处方数量的水平和趋势。
从2010年1月开始，俄亥俄州所有急诊医生开具的处方数量每月减少0.3%（95%置信区间[CI] -0.49%至-0.15%）。2012年4月指南的实施与全州每月处方总量水平降低12%（95%CI -17.7%至-6.3%）相关，且相对于指南前趋势，趋势额外下降0.9%（95%CI -1.1%至-0.7%）。指南对超过3天用量的每月总处方的估计影响是水平降低11.2%（95%CI -18.8%至-3.6%），指南实施后每月趋势额外下降0.9%（95%CI -1.3%至-0.5%）。指南还与5种单独阿片类药物中每种药物的处方减少相关，效果各异。
在俄亥俄州，急诊医生阿片类药物处方指南与急诊医生开具的阿片类药物处方数量减少相关。尽管指南的引入与其他阿片类药物相关干预措施同时发生，但我们的研究结果表明指南对处方行为有额外影响。类似的指南可能也有潜力在其他地理区域和其他专科减少阿片类药物处方。
