Grasso Michael A, Dezman Zachary D W, Grasso Clare T, Jerrard David A
Assistant Professor, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
J Opioid Manag. 2017 Mar/Apr;13(2):77-84. doi: 10.5055/jom.2017.0371.
This study sought to characterize national patterns for opioid pain medication (OPM) prescriptions received during emergency medical encounters in the Veterans Health Administration (VA).
The authors conducted a retrospective study of all emergency department (ED) visits by adults in the VA between January 2009 and June 2015. We examined demographics, comorbidities, utilization measures, diagnoses, and prescriptions.
The percentage of ED visits that culminated in the receipt of a prescription for an OPM.
There were 6,721,134 emergency medical visits by 1,708,545 individuals during the study period. An OPM was prescribed during 913,872 visits (13.6 percent), and 407,408 individuals (27.5 percent) received at least one OPM prescription. Prescriptions for OPMs peaked in 2011 at 14.5 percent, declining to 12.3 percent in 2015. The percentage of prescriptions limited to 12 pills increased from 25.0 to 32.4 percent. The heaviest users (top 1.5 percent, n = 7,247) received an average 602.5 total doses, and had at least 10 ED visits during the study period. The most frequently prescribed OPMs were acetaminophen/hydrocodone, followed by tramadol and acetaminophen/oxycodone. Receiving a prescription was associated with younger patients, musculoskeletal diagnoses, higher pain scores, a history of chronic pain, a history of mental illness, a history of substance abuse, prior heavy prescription OPM use, and lower participation in outpatient services.
The writing of OPM prescriptions after an ED visit is on the decline in the VA. Compliance with prescribing guidelines is increasing, but is not yet at goal.
本研究旨在描述退伍军人健康管理局（VA）紧急医疗就诊期间开具的阿片类镇痛药（OPM）处方的全国模式。
作者对2009年1月至2015年6月期间VA中成年人的所有急诊科（ED）就诊进行了回顾性研究。我们检查了人口统计学、合并症、使用情况指标、诊断和处方。
以开具OPM处方告终的ED就诊百分比。
在研究期间，1,708,545名个体进行了6,721,134次紧急医疗就诊。在913,872次就诊（13.6%）中开具了OPM处方，407,408名个体（27.5%）至少收到了一张OPM处方。OPM处方在2011年达到峰值，为14.5%，2015年降至12.3%。限于12片的处方百分比从25.0%增加到32.4%。使用量最大的用户（前1.5%，n = 7,247）平均共接受602.5剂，并且在研究期间至少有10次ED就诊。最常开具的OPM是对乙酰氨基酚/氢可酮，其次是曲马多和对乙酰氨基酚/羟考酮。开具处方与年轻患者、肌肉骨骼诊断、较高的疼痛评分、慢性疼痛史、精神疾病史、药物滥用史、先前大量使用OPM处方以及较低的门诊服务参与率有关。
VA中ED就诊后开具OPM处方的情况正在下降。对处方指南的遵守情况正在增加，但尚未达到目标。
