University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, MD (MAG); University of Maryland Baltimore County, Department of Computer Science and Electrical Engineering, Baltimore, MD (CTG); University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, MD (DAJ).
J Addict Med. 2017 Nov/Dec;11(6):483-488. doi: 10.1097/ADM.0000000000000352.
The purpose of this study was to identify national opioid pain medication (OPM) prescribing trends within the Veterans Health Administration (VA), and assess the impact of educational campaigns introduced in 2010 and 2013.
We created a national cohort that documents more than 21 million patient records and 97 million outpatient OPM prescriptions covering a 17-year period. We examined OPM prescriptions in emergency departments, outpatient clinics, and inpatient settings.
The cohort accounted for 2.5 billion outpatient clinic visits, 18.9 million emergency department visits, and 12.4 million hospital admissions. The number of OPM prescriptions peaked in 2011, when they were provided during 5% of all outpatient visits and 15% of all emergency department visits. The morphine milligram equivalents (MMEs) peaked in 2014 at almost 17 billion in outpatient clinics and at 137 million in emergency departments. In 2016, OPM prescriptions were down 37% in outpatient clinics and 23% in emergency departments, and MMEs were down 30% in both settings. Prescriptions for hydrocodone and tramadol increased markedly between 2011 and 2015. OPM doses in inpatient settings continued to rise until 2015.
We used a large national cohort to study trends in OPM prescriptions within the VA. Educational efforts to reduce the number of OPM prescriptions coincided with these reductions, but were initially associated with an increase in OPM dosage, an increase in the use of tramadol and hydrocodone, and an increase in the use of OPMs in inpatient settings.
本研究旨在确定退伍军人事务部（VA）内国家阿片类止痛药（OPM）的处方趋势，并评估 2010 年和 2013 年推出的教育活动的影响。
我们创建了一个全国性队列，记录了超过 2100 万患者记录和 9700 万门诊 OPM 处方，涵盖了 17 年的时间。我们检查了急诊科、门诊和住院患者的 OPM 处方。
该队列包括 25 亿次门诊就诊、1890 万次急诊就诊和 1240 万次住院治疗。OPM 处方数量在 2011 年达到峰值，当时它们在所有门诊就诊中的占比为 5%，在所有急诊就诊中的占比为 15%。吗啡毫克当量（MME）在 2014 年达到顶峰，门诊就诊中达到近 170 亿，急诊就诊中达到 1.37 亿。2016 年，门诊和急诊的 OPM 处方量分别下降了 37%和 23%，两种情况下的 MME 均下降了 30%。氢可酮和曲马多的处方量在 2011 年至 2015 年间显著增加。住院患者的 OPM 剂量一直持续上升，直到 2015 年。
我们使用大型全国性队列研究了退伍军人事务部内 OPM 处方的趋势。减少 OPM 处方数量的教育努力与这些减少相吻合，但最初与 OPM 剂量增加、曲马多和氢可酮使用增加以及住院患者中 OPM 使用增加有关。
