电子病历警报与高危退伍军人患者阿片类药物和苯二氮䓬类药物联合用药减少相关。
Electronic Medical Record Alert Associated With Reduced Opioid and Benzodiazepine Coprescribing in High-risk Veteran Patients.
机构信息
Veterans Affairs (VA) Health Services Research & Development (HSR&D) Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care.
VA Puget Sound Center of Excellence in Substance Abuse Treatment and Education.
出版信息
Med Care. 2018 Feb;56(2):171-178. doi: 10.1097/MLR.0000000000000861.
BACKGROUND
Over the past decade, overdoses involving opioids and benzodiazepines have risen at alarming rates, making reductions in coprescribing of these medications a priority, particularly among patients who may be susceptible to adverse events due to high-risk conditions.
OBJECTIVES
This quality improvement project evaluated the effectiveness of a medication alert designed to reduce opioid and benzodiazepine coprescribing among Veterans with known high-risk conditions (substance use, sleep apnea, suicide-risk, age 65 and above) at 1 Veterans Affairs (VA) health care system.
METHODS
Prescribers were exposed to the point-of-prescribing alert for 12 months. For each high-risk cohort we used interrupted time series design to examine population trends in coprescribing 12 months after alert launch adjusting for coprescribing 12 months before launch, demographics and clinical covariates. Trends at the alert site were compared with those of a similar VA health care system without the alert. Secondary analyses examined population trends in opioid and benzodiazepine prescribing separately.
RESULTS
Over 12 months, the alert activated for 1332 patients. Proportions of patients with concurrent prescriptions decreased significantly postalert launch among substance use [adjusted odds ratio (AOR)=0.97; 95% confidence interval (CI)=0.96-0.99; 12-month decrease=25.0%], sleep apnea (AOR=0.97, 95% CI=0.95-0.98, 12-month decrease=38.5%), and suicide-risk (AOR=0.94, 95% CI=0.91-0.98, 12-month decrease=61.5%) cohorts at the alert site. Decreases in coprescribing were significantly different from the comparison site among suicide-risk (AOR=0.92, 95% CI=0.86-0.97) and sleep apnea (AOR=0.98, 95% CI=0.96-1.00) cohorts. Significant decreases in benzodiazepine prescribing trends were observed at the alert site only.
CONCLUSIONS
Medication alerts hold promise as a means of reducing opioid and benzodiazepine coprescribing among certain high-risk groups.
背景
在过去的十年中，涉及阿片类药物和苯二氮䓬类药物的过量用药率以惊人的速度上升，因此减少这些药物的联合用药成为当务之急，尤其是在那些由于高危情况可能容易发生不良事件的患者中。
目的
本质量改进项目评估了一种药物警报的有效性，该警报旨在减少退伍军人医疗保健系统中已知具有高危情况（药物使用、睡眠呼吸暂停、自杀风险、年龄 65 岁及以上）的退伍军人中阿片类药物和苯二氮䓬类药物的联合用药。
方法
为 12 个月的时间内为每位开处方者提供了点医嘱警报。对于每个高危队列，我们使用中断时间序列设计，在启动警报后 12 个月内，根据启动前 12 个月的联合用药情况、人口统计学和临床协变量，检查联合用药的人群趋势。在警报现场的趋势与没有警报的类似退伍军人医疗保健系统进行了比较。次要分析分别检查了阿片类药物和苯二氮䓬类药物的处方人群趋势。
结果
在 12 个月内，警报为 1332 名患者激活。在启动警报后，药物使用（调整后优势比（AOR）=0.97；95%置信区间（CI）=0.96-0.99；12 个月减少量=25.0%）、睡眠呼吸暂停（AOR=0.97，95%CI=0.95-0.98，12 个月减少量=38.5%）和自杀风险（AOR=0.94，95%CI=0.91-0.98，12 个月减少量=61.5%）队列中，同时服用这些药物的患者比例显著下降。在自杀风险（AOR=0.92，95%CI=0.86-0.97）和睡眠呼吸暂停（AOR=0.98，95%CI=0.96-1.00）队列中，警报现场的联合用药减少与比较现场相比差异有统计学意义。仅在警报现场观察到苯二氮䓬类药物处方趋势的显著下降。
结论
药物警报作为减少某些高危人群中阿片类药物和苯二氮䓬类药物联合用药的一种手段具有很大的潜力。
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