初始提供者专业与新诊断的下腰痛和下肢疼痛患者的长期阿片类药物使用相关。
Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain.
机构信息
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA.
Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA.
出版信息
Spine (Phila Pa 1976). 2019 Feb 1;44(3):211-218. doi: 10.1097/BRS.0000000000002840.
STUDY DESIGN
Retrospective longitudinal cohort analysis of patients diagnosed in 2010, with continuous enrollment 6 months prior to and 12 months following the initial visit.
OBJECTIVE
To determine whether provider specialty influences patterns of opiate utilization long after initial diagnosis.
SUMMARY OF BACKGROUND DATA
Patients with low back pain present to a variety of providers and receive a spectrum of treatments, including opiate medications. The impact of initial provider type on opiate use in this population is uncertain.
METHODS
We performed a retrospective analysis of opiate-naïve adult patients in the United States with newly diagnosed low back or lower extremity pain. We estimated the risk of early opiate prescription (≤14 d from diagnosis) and long-term opiate use (≥six prescriptions in 12 mo) based on the provider type at initial diagnosis using multivariable logistic regression, adjusting for patient demographics and comorbidities.
RESULTS
We identified 478,981 newly diagnosed opiate-naïve patients. Of these, 40.4% received an opiate prescription within 1 year and 4.0% met criteria for long-term use. The most common initial provider type was family practice, associated with a 24.4% risk of early opiate prescription (95% CI, 24.1-24.6) and a 2.0% risk of long-term opiate use (95% CI, 2.0-2.1). Risk of receiving an early opiate prescription was higher among patients initially diagnosed by emergency medicine (43.1%; 95% CI, 41.6-44.5) or at an urgent care facility (40.8%; 95% CI, 39.4-42.3). Risk of long-term opiate use was highest for patients initially diagnosed by pain management/anesthesia (6.7%; 95% CI, 6.0-7.3) or physical medicine and rehabilitation (3.4%; 95% CI, 3.1-3.8) providers.
CONCLUSION
Initial provider type influences early opiate prescription and long-term opiate use among opiate-naïve patients with newly diagnosed low back and lower extremity pain.
LEVEL OF EVIDENCE
研究设计
对 2010 年确诊的患者进行回顾性纵向队列分析，在初始就诊前连续 6 个月和就诊后 12 个月进行连续登记。
目的
确定提供者的专业是否会影响初始诊断后很长一段时间内阿片类药物的使用模式。
背景资料概要
腰痛患者就诊于各种提供者，并接受各种治疗，包括阿片类药物。初始提供者类型对该人群中阿片类药物使用的影响尚不确定。
方法
我们对美国新诊断为腰痛或下肢疼痛的阿片类药物初治成年患者进行了回顾性分析。我们使用多变量逻辑回归，根据初始诊断时的提供者类型，估计早期阿片类药物处方（诊断后≤14 天）和长期阿片类药物使用（12 个月内≥6 个处方）的风险，调整了患者的人口统计学和合并症。
结果
我们确定了 478981 名新诊断的阿片类药物初治患者。其中，40.4%的患者在 1 年内接受了阿片类药物处方，4.0%符合长期使用标准。最常见的初始提供者类型是家庭医生，其早期阿片类药物处方的风险为 24.4%（95%CI，24.1-24.6），长期阿片类药物使用的风险为 2.0%（95%CI，2.0-2.1）。最初由急诊医学（43.1%；95%CI，41.6-44.5）或紧急护理机构（40.8%；95%CI，39.4-42.3）诊断的患者接受早期阿片类药物处方的风险更高。长期阿片类药物使用的风险最高的是最初由疼痛管理/麻醉（6.7%；95%CI，6.0-7.3）或物理医学和康复（3.4%；95%CI，3.1-3.8）提供者诊断的患者。
结论
在新诊断为腰痛和下肢疼痛的阿片类药物初治患者中，初始提供者类型会影响早期阿片类药物处方和长期阿片类药物使用。
证据水平
3 级
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