Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA.
Pharmacoepidemiol Drug Saf. 2019 Jan;28(1):31-38. doi: 10.1002/pds.4568. Epub 2018 Jun 4.
To estimate the proportion of residents newly initiating long-acting opioids in comparison to residents initiating short-acting opioids and examine variation in long-acting opioid initiation by region and resident characteristics.
This cross-sectional study included 182 735 long-stay nursing home residents in 13 881 US nursing homes who were Medicare beneficiaries during 2011 to 2013 and initiated a short-acting or long-acting opioid (excluding residents <50 years old, those with cancer, or receiving hospice care). Medicare Part D prescription claims were used to identify residents as newly initiating short-acting or long-acting opioids, defined as having a prescription claim for an opioid with no prior opioid prescriptions in the preceding 60 days. We estimated the overall proportion of initiators prescribed long-acting opioids. Regional variation was examined by mapping results by state and hospital referral regions. Logistic models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
Two percent of opioid initiators were prescribed long-acting opioids. State variation in long-acting opioid initiation ranged from 0.6% to 7.5% (5th-95th percentiles: 0.6-6.4%). Resident characteristics associated with increased long-acting opioid initiation included severe physical limitations (vs none/mild limitations; aOR: 2.13, 95% CI: 1.92-2.37) and pain (staff-assessed vs no pain; aOR: 1.59 95% CI: 1.40-1.80), whereas being non-White was inversely associated (non-Hispanic black vs non-Hispanic white; aOR: 0.70, 95% CI: 0.62-0.79).
United States nursing home residents predominantly initiate short-acting opioids in accordance with Center for Disease Control and Prevention guidelines. Documented variation by geographic and resident characteristics suggests that improvements are possible.
评估新开始使用长效阿片类药物的居民比例与开始使用短效阿片类药物的居民比例，并考察地区和居民特征对长效阿片类药物起始使用的影响。
这项横断面研究纳入了 2011 年至 2013 年期间在全美 13881 家养老院中居住时间超过 60 天的 182735 名医疗保险受益居民，这些居民正在接受短期或长效阿片类药物治疗（不包括年龄<50 岁、患有癌症或正在接受临终关怀的居民）。使用医疗保险处方数据库来确定新开始使用短效或长效阿片类药物的居民，定义为在过去 60 天内没有使用过阿片类药物处方，随后开出阿片类药物处方。我们评估了处方长效阿片类药物的起始使用者的总体比例。通过州和医院转诊区的地图来研究区域差异。使用逻辑回归模型来评估调整后的优势比（aOR）和 95%置信区间（CI）。
2%的阿片类药物起始使用者开了长效阿片类药物处方。长效阿片类药物起始使用的州间差异范围为 0.6%至 7.5%（第 5 百分位至第 95 百分位：0.6%至 6.4%）。与增加长效阿片类药物起始使用相关的居民特征包括严重的身体限制（无/轻度限制与严重身体限制相比；aOR：2.13，95%CI：1.92-2.37）和疼痛（由工作人员评估与无痛相比；aOR：1.59，95%CI：1.40-1.80），而非白人居民则相反（非西班牙裔黑人与非西班牙裔白人相比；aOR：0.70，95%CI：0.62-0.79）。
美国养老院居民主要按照疾病控制与预防中心的指南开始使用短效阿片类药物。根据地理位置和居民特征记录的差异表明，仍有改进的空间。
