Steinmetz C N, Zheng C, Okunseri E, Szabo A, Okunseri C
Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA.
JDR Clin Trans Res. 2017 Jul;2(3):241-248. doi: 10.1177/2380084417693826. Epub 2017 Feb 9.
The prescription of opioid analgesics by dental professionals is widespread in the United States. Policy makers, government agencies, and professional organizations consider this phenomenon a growing public health concern. This study examined trends in the prescription of opioid analgesics for adults by dental professionals and associated factors in the United States. Data from the Medical Expenditure Panel Survey (1996-2013) were analyzed. Descriptive statistics were calculated separately for each year. Logistic regression analyses were conducted to estimate the overall trend during the period with and without adjusting for dental procedures and personal characteristics. Survey weights were incorporated to handle the sampling design. The prescription of opioid analgesics following dental care increased over time. After adjusting for sociodemographic factors, source of payment, and type of dental procedure, the odds ratio (OR) of prescribing opioid analgesics following a dental visit per each decade difference was 1.28 (95% confidence interval [CI], 1.19-1.38). Surgical, root canal, and implant procedures had the highest rates of opioid prescriptions and the greatest increases in rates over the study period. After adjusting for personal characteristics and type of dental procedure, the OR of receiving a prescription for opioids comparing blacks, Asians, and Hispanics to whites was 1.29 (95% CI, 1.17-1.41), 0.57 (95% CI, 0.47-0.70), and 0.84 (95% CI, 0.75-0.95), respectively. Opioid analgesic prescriptions following dental visits increased over time after adjusting for personal characteristics and type of dental procedure. The odds of receiving a prescription for opioids were higher for certain racial/ethnic minority groups. This study highlights dental professionals prescribing practices of opioid analgesics by following dental treatments in the United States. With this knowledge, appropriate guidelines, protocols, and policies can be developed and implemented to address any inappropriate prescribing practices of opioid analgesics. In addition, this information could lead to an improvement in the prescribing practices of dental professionals and to evidence-based therapeutic decision making.
在美国,牙科专业人员开具阿片类镇痛药的处方十分普遍。政策制定者、政府机构和专业组织认为这一现象对公众健康的影响日益严重。本研究调查了美国牙科专业人员为成年人开具阿片类镇痛药的处方趋势及相关因素。分析了医疗支出面板调查(1996 - 2013年)的数据。每年分别计算描述性统计数据。进行逻辑回归分析以估计该时期内调整和未调整牙科手术及个人特征情况下的总体趋势。纳入调查权重以处理抽样设计问题。牙科护理后开具阿片类镇痛药的处方随时间增加。在调整社会人口学因素、支付来源和牙科手术类型后,每十年差异中牙科就诊后开具阿片类镇痛药的比值比(OR)为1.28(95%置信区间[CI],1.19 - 1.38)。外科手术、根管治疗和种植牙手术的阿片类药物处方率最高,且在研究期间增长率最大。在调整个人特征和牙科手术类型后,黑人、亚洲人和西班牙裔与白人相比,接受阿片类药物处方的OR分别为1.29(95%CI,1.17 - 1.41)、0.57(95%CI,0.47 - 0.70)和0.84(95%CI,0.75 - 0.95)。在调整个人特征和牙科手术类型后,牙科就诊后阿片类镇痛药的处方随时间增加。某些种族/族裔少数群体接受阿片类药物处方的几率更高。本研究突出了美国牙科专业人员在牙科治疗后开具阿片类镇痛药的处方行为。有了这些信息,就可以制定并实施适当的指南、方案和政策,以解决阿片类镇痛药的任何不适当处方行为。此外,这些信息可能会改善牙科专业人员的处方行为,并促进基于证据的治疗决策。