Mundkur Mallika L, Rough Kathryn, Huybrechts Krista F, Levin Raisa, Gagne Joshua J, Desai Rishi J, Patorno Elisabetta, Choudhry Niteesh K, Bateman Brian T
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Pharmacoepidemiol Drug Saf. 2018 May;27(5):495-503. doi: 10.1002/pds.4322. Epub 2017 Oct 2.
The primary objective of this study was to characterize variation in patterns of opioid prescribing within primary care settings at first visits for pain, and to describe variation by condition, geography, and patient characteristics.
2014 healthcare utilization data from Optum's Clinformatics™ DataMart were used to evaluate individuals 18 years or older with an initial presentation to primary care for 1 of 10 common pain conditions. The main outcomes assessed were (1) the proportion of first visits for pain associated with an opioid prescription fill and (2) the proportion of opioid prescriptions with >7 days' supply.
We identified 205 560 individuals who met inclusion criteria; 9.1% of all visits were associated with an opioid fill, ranging from 4.1% (headache) to 28.2% (dental pain). Approximately half (46%) of all opioid prescriptions supplied more than 7 days, and 10% of prescriptions supplied ≥30 days. We observed a 4-fold variation in rates of opioid initiation by state, with highest rates of prescribing in Alabama (16.6%) and lowest rates in New York (3.7%).
In 2014, nearly half of all patients filling opioid prescriptions received more than 7 days' of opioids in an initial prescription. Policies limiting initial supplies have the potential to substantially impact opioid prescribing in the primary care setting.
本研究的主要目的是描述在初级保健机构初次就诊时因疼痛开具阿片类药物的模式变化，并按病情、地理位置和患者特征描述这种变化。
利用Optum公司Clinformatics™ 数据集市2014年的医疗保健利用数据，对18岁及以上因10种常见疼痛病症之一首次到初级保健机构就诊的个体进行评估。评估的主要结果为：（1）因开具阿片类药物处方而进行的疼痛初次就诊比例；（2）供应天数超过7天的阿片类药物处方比例。
我们确定了205560名符合纳入标准的个体；所有就诊中有9.1%与开具阿片类药物处方有关，范围从4.1%（头痛）到28.2%（牙痛）。所有阿片类药物处方中约有一半（46%）供应超过7天，10%的处方供应≥30天。我们观察到各州阿片类药物起始使用率有4倍的差异，阿拉巴马州的处方率最高（16.6%），纽约州最低（3.7%）。
2014年，所有开具阿片类药物处方的患者中，近一半在初次处方中获得了超过7天用量的阿片类药物。限制初始供应量的政策可能会对初级保健机构中阿片类药物的处方开具产生重大影响。
