美国既往阿片类药物未使用者术后阿片类药物处方的过渡期护理：回顾性研究。
Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: a Retrospective Review.
机构信息
Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
出版信息
J Gen Intern Med. 2018 Oct;33(10):1685-1691. doi: 10.1007/s11606-018-4463-1. Epub 2018 Jun 11.
BACKGROUND
New persistent opioid use is a common postoperative complication, with 6% of previously opioid-naïve patients continuing to fill opioid prescriptions 3-6 months after surgery. Despite these risks, it is unknown which specialties prescribe opioids to these vulnerable patients.
OBJECTIVE
To identify specialties prescribing opioids to surgical patients who develop new persistent opioid use.
DESIGN, SETTING, AND PARTICIPANTS: Using a national dataset of insurance claims, we identified opioid-naïve patients aged 18-64 years undergoing surgical procedures (2008-2014) who continued filling opioid prescriptions 3 to 6 months after surgery. We then examined opioid prescriptions claims during the 12 months after surgery, and identified prescribing physician specialty using National Provider Identifier codes.
MAIN MEASURES
Percentage of opioid prescriptions provided by each specialty evaluated at 90-day intervals during the 12 months after surgery.
KEY RESULTS
We identified 5276 opioid-naïve patients who developed new persistent opioid use. During the first 3 months after surgery, surgeons accounted for 69% of opioid prescriptions, primary care physicians accounted for 13%, Emergency Medicine accounted for 2%, Physical Medicine & Rehabilitation (PM&R)/Pain Medicine accounted for 1%, and all other specialties accounted for 15%. In contrast, 9 to 12 months after surgery, surgeons accounted for only 11% of opioid prescriptions, primary care physicians accounted for 53%, Emergency Medicine accounted for 5%, PM&R/Pain Medicine accounted for 6%, and all other specialties provided 25%.
CONCLUSIONS
Among surgical patients who developed new persistent opioid use, surgeons provide the majority of opioid prescriptions during the first 3 months after surgery. By 9 to 12 months after surgery, however, the majority of opioid prescriptions were provided by primary care physicians. Enhanced care coordination between surgeons and primary care physicians could allow earlier identification of patients at risk for new persistent opioid use to prevent misuse and dependence.
背景
新的持续性阿片类药物使用是一种常见的术后并发症，6%的以前未使用过阿片类药物的患者在手术后 3-6 个月继续填写阿片类药物处方。尽管存在这些风险，但尚不清楚哪些专业为这些脆弱患者开具阿片类药物。
目的
确定为出现新的持续性阿片类药物使用的手术患者开具阿片类药物的专业。
设计、地点和参与者：我们使用全国性的保险索赔数据集，确定了 18-64 岁接受手术（2008-2014 年）的阿片类药物未使用患者，他们在手术后 3 至 6 个月继续填写阿片类药物处方。然后，我们检查了手术后 12 个月内的阿片类药物处方，并使用国家提供者标识符代码确定了处方医生的专业。
主要措施
在手术后 12 个月的 90 天间隔内，每个专业评估的阿片类药物处方的百分比。
主要结果
我们确定了 5276 名出现新的持续性阿片类药物使用的阿片类药物未使用患者。在手术后的前 3 个月，外科医生开出的阿片类药物处方占 69%，初级保健医生开出的占 13%，急诊医学占 2%，物理医学与康复/疼痛医学占 1%，其他所有专业占 15%。相比之下，在手术后 9 至 12 个月，外科医生开出的阿片类药物处方仅占 11%，初级保健医生开出的占 53%，急诊医学占 5%，物理医学与康复/疼痛医学占 6%，其他所有专业提供 25%。
结论
在出现新的持续性阿片类药物使用的手术患者中，外科医生在手术后的前 3 个月内提供了大部分阿片类药物处方。然而，在手术后 9 至 12 个月，大多数阿片类药物处方由初级保健医生提供。外科医生和初级保健医生之间加强护理协调可以更早地识别有新的持续性阿片类药物使用风险的患者，以防止滥用和依赖。
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