美国初级保健医生为医疗保险受益人群开具苯二氮䓬类药物的县际和医师差异。
County and Physician Variation in Benzodiazepine Prescribing to Medicare Beneficiaries by Primary Care Physicians in the USA.
机构信息
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
出版信息
J Gen Intern Med. 2018 Dec;33(12):2180-2188. doi: 10.1007/s11606-018-4670-9. Epub 2018 Sep 24.
BACKGROUND
Physicians widely prescribe benzodiazepines (BZD) despite well-recognized harms.
OBJECTIVE
To determine county and provider characteristics that predict high-intensity BZD prescribing by primary care physicians (PCPs) to Medicare beneficiaries.
DESIGN
Cross-sectional analysis of the 2015 Medicare Part D Public Use Files (PUF).
SUBJECTS
n = 122,054 PCPs who prescribed 37.3 billion medication days.
MAIN MEASURES
Primary outcome was intensity of BZD prescribing (days prescribed/total medication days) at the county- and physician levels. PCP and county characteristics were derived from the Part D PUF, Area Health Resources Files, and County Health Rankings. Logistic regression determined the characteristics associated with high-intensity (top quartile) BZD prescribing.
KEY RESULTS
Beneficiaries were prescribed over 1.2 billion days of BZD in 2015, accounting for 2.3% of all medication days prescribed in Part D. Top quartile counties had 3.1 times higher BZD prescribing than the lowest (3.4% vs. 1.1%; F = 3293.8, df = 3, p < 0.001). Adjusting for county-level demographics and health care system characteristics (including supply of mental health providers), counties with more adults with at least some college had lower odds of high-intensity prescribing (per 5% increase, adjusted odds ratio [AOR] 0.80, 99% confidence interval (CI) 0.73-0.87, p < 0.001), as did higher income counties (per US$1000 increase, AOR 0.93, CI 0.91-0.95, p < 0.001). Top quartile PCPs prescribed at 6.5 times the rate of the bottom (3.9% vs. 0.6%; F = 63,910.2, df = 3, p < 0.001). High-intensity opioid prescribing (AOR 4.18, CI 3.90-4.48, p < 0.001) was the characteristic most strongly associated with BZD prescribing.
CONCLUSIONS
BZD prescribing appears to vary across counties and providers and is related to non-patient characteristics. Further work is needed to understand how such non-clinical factors drive variation.
背景
尽管苯二氮䓬类药物（BZD）的危害已得到广泛认可，医生仍广泛开具此类药物。
目的
确定初级保健医生（PCP）向医疗保险受益人开具高剂量 BZD 的县和提供者特征。
设计
对 2015 年医疗保险部分 D 公共使用文件（PUF）进行的横断面分析。
受试者
122054 名开具 373 亿药物天的 PCP。
主要措施
主要结局是县和医生层面 BZD 开具强度（开具的天数/总药物天数）。PCP 和县的特征来自部分 D PUF、区域卫生资源文件和县卫生排名。逻辑回归确定了与高剂量（四分位高位）BZD 开具相关的特征。
主要结果
2015 年，受益人为 BZD 开具了超过 12 亿天的药物，占部分 D 开具的所有药物天的 2.3%。四分位高位县的 BZD 开具量是最低位县的 3.1 倍（3.4%比 1.1%；F=3293.8，df=3，p<0.001）。在调整了县级人口统计学和医疗保健系统特征（包括心理健康提供者的供应）后，至少有一些大学学历的成年人比例较高的县开具高剂量 BZD 的可能性较低（每增加 5%，调整后的优势比[OR]0.80，99%置信区间[CI]0.73-0.87，p<0.001），收入较高的县也是如此（每增加 1000 美元，OR 0.93，CI 0.91-0.95，p<0.001）。四分位高位 PCP 的开具率是最低位 PCP 的 6.5 倍（3.9%比 0.6%；F=63910.2，df=3，p<0.001）。高剂量阿片类药物开具（OR 4.18，CI 3.90-4.48，p<0.001）与 BZD 开具最密切相关。
结论
BZD 的开具情况似乎在县和提供者之间存在差异，并且与非患者特征有关。需要进一步研究了解如何驱动这种非临床因素的变化。
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