Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Addiction. 2018 Apr;113(4):677-686. doi: 10.1111/add.14068. Epub 2017 Nov 29.
(1) To characterize the amount of prescription opioids prescribed for high-risk patients by low-volume prescribers; (2) to quantify how high- and low-volume prescribers differ systematically in their prescribing patterns.
Cross-sectional study using 2015 longitudinal, all-payer QuintilesIMS pharmacy claims. We conducted an aggregated analysis for the first aim and an individual-level analysis for the second aim.
California, Florida, Georgia, Maryland, and Washington, USA.
Among 4 046 275 patients, we identified 375 848 concomitant users (filling more than 30-days of concomitant opioids and benzodiazepines), 150 814 chronic users (using 100+ morphine milligram equivalents (MMEs) per day for more than 90 days), and 3190 patients prescribed opioids by > 3 prescribers and filling opioids at > 3 pharmacies during any 90-day period. Among 192 126 prescribers, we identified 8023 high-volume prescribers, who comprised the highest fifth percentile of opioid volume during four calendar quarters.
(1) MME dose per transaction, (2) days supplied per transaction, (3) total opioid volume per patient and (4) number of prescriptions per patient. We also examined differences in opioid dispensing between high- and low-volume prescribers among patients receiving opioids from both.
Low-volume prescribers accounted for 15-29% of opioid volume and 18-56% of opioid prescriptions for high-risk patients, compared with 28-37% and 53-58% for low-risk patients. After accounting for state of residence, comorbid burden, prescriber specialty and care sequence, patients were more likely to receive higher doses (60.9 versus 53.2 MMEs per day, P < 0.01), longer supplies (22.1 versus 15.6 days, P < 0.01), more prescriptions (4.0 versus 2.6 prescriptions, P < 0.01) and greater opioid volume (5.6 versus 1.9 g, P < 0.01) from high- than low-volume prescribers.
In the United States, high-risk patients obtain a substantial proportion of prescription opioids from low-volume prescribers. The differences in prescribing patterns between high- and low-volume prescribers suggest the importance of interventions targeting prescriber behaviors.
(1) 描述低用量处方医师为高风险患者开具的处方类阿片类药物的数量；(2) 量化高用量和低用量处方医师在处方模式上的系统差异。
使用 2015 年 QuintilesIMS 纵向全支付者药房理赔数据进行的横断面研究。我们对第一项目的进行了汇总分析，对第二项目的进行了个体水平分析。
美国加利福尼亚州、佛罗里达州、佐治亚州、马里兰州和华盛顿州。
在 4046275 名患者中，我们确定了 375848 名同时使用者（同时使用超过 30 天的处方类阿片类药物和苯二氮䓬类药物）、150814 名慢性使用者（每天使用 100 毫克以上的美沙酮等效物（MME）超过 90 天）和 3190 名患者在任何 90 天期间由>3 名医师开具处方，并在>3 家药店配药。在 192126 名医师中，我们确定了 8023 名高用量处方医师，他们在四个日历季度的阿片类药物用量中最高占第五百分位。
（1）每笔交易的 MME 剂量，（2）每笔交易的供应天数，（3）每位患者的总阿片类药物用量和（4）每位患者的处方数量。我们还研究了在接受高风险患者的阿片类药物治疗时，高用量和低用量处方医师之间在阿片类药物配药方面的差异。
与低风险患者相比，低用量处方医师开具的阿片类药物量占 15-29%，处方量占 18-56%，而高用量处方医师开具的阿片类药物量占 28-37%，处方量占 53-58%。在考虑到居住州、合并症负担、医师专业和护理顺序后，患者更有可能接受更高的剂量（每天 60.9 与 53.2 MME，P<0.01）、更长的供应（22.1 与 15.6 天，P<0.01）、更多的处方（4.0 与 2.6 张，P<0.01）和更高的阿片类药物用量（5.6 与 1.9 克，P<0.01）从高用量处方医师。
在美国，高风险患者从低用量处方医师那里获得了大量的处方类阿片类药物。高用量和低用量处方医师之间的处方模式差异表明，针对处方医师行为的干预措施很重要。
