Department of Economics, Finance, and Quantitative Analysis, Samford University, Birmingham, AL, USA.
Department of Accounting, Samford University, Birmingham, AL, USA.
Fam Pract. 2019 Jul 31;36(4):467-472. doi: 10.1093/fampra/cmy090.
In the USA, opioid overdose accounted for more than 60% of drug overdose deaths in 2015. Of these deaths, 40% were due to use of prescription opioids.
The aims of the study were to (i) study family medicine physician opioid-prescribing rate and duration of prescription, (ii) study the distribution of prescription by medication potency, (iii) study opioid-prescribing trends in health care shortage areas and (iv) study the association between extreme high prescribing rates and medical board discipline.
This is a retrospective cross-sectional study of the 2015 Medicare Part D claim data.
Family practitioners have opioid prescription rates (5.6%) similar to medical subspecialists (6.0%), but lower than pain specialists (53.2%) and surgical specialists (36.6%). Family practitioners have an average opioid prescription duration (21.5 days) similar to medical subspecialists (23.1 days) and pain specialists (27.1 days), but longer than surgical specialists (8.9 days). Family practitioners tend to prescribe lower potency opioids. Family practitioners in rural health care shortage areas have a higher opioid prescription rate than other family practitioners (6.5% versus 5.6%). Among the 52 family practitioners who prescribed opioids as frequently as pain specialists, 26 of the 52 (50%) were certified in pain management or worked with a partner certified in pain management. Of the other 26 family practitioners, 3 (12%) had medical board disciplinary actions regarding opioid prescription.
While monitoring extreme prescribers is important and needs to be continued, the next step in policies to reduce prescription opioids will require systemic change, especially providing support for family practitioners in rural health care shortage areas.
2015 年，在美国，阿片类药物过量导致的药物过量死亡人数超过 60%。其中，40%的死亡归因于处方类阿片类药物的使用。
本研究旨在：(i)研究家庭医生开具阿片类药物的处方率和处方持续时间；(ii)研究药物效力分布的处方情况；(iii)研究医疗资源短缺地区的阿片类药物处方趋势；(iv)研究极端高处方率与医疗委员会纪律处分之间的关联。
这是一项对 2015 年医疗保险处方药物 D 部分索赔数据的回顾性横截面研究。
家庭医生的阿片类药物处方率（5.6%）与医学亚专科医生（6.0%）相似，但低于疼痛专科医生（53.2%）和外科专科医生（36.6%）。家庭医生的阿片类药物处方持续时间（21.5 天）与医学亚专科医生（23.1 天）和疼痛专科医生（27.1 天）相似，但长于外科专科医生（8.9 天）。家庭医生倾向于开具效力较低的阿片类药物。农村医疗资源短缺地区的家庭医生开具阿片类药物的处方率高于其他家庭医生（6.5%比 5.6%）。在 52 名开出与疼痛专科医生同样频繁的阿片类药物处方的家庭医生中，26 名（50%）具有疼痛管理认证或与具有疼痛管理认证的合作伙伴合作。在其他 26 名家庭医生中，有 3 名（12%）因阿片类药物处方问题受到医疗委员会纪律处分。
虽然监测极端处方医生很重要，需要继续进行，但减少处方类阿片类药物政策的下一步需要进行系统性变革，特别是为农村医疗资源短缺地区的家庭医生提供支持。
