Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Department of Epidemiology, University of Washington, Seattle, WA, USA.
Pharmacoepidemiol Drug Saf. 2019 Jan;28(1):90-96. doi: 10.1002/pds.4678. Epub 2018 Oct 30.
The purpose of the study is to determine whether initiatives to improve the safety of opioid prescribing decreased injuries in people using chronic opioid therapy (COT).
We conducted an interrupted time series analysis using data from Group Health (GH), an integrated health care delivery system in the United States. In 2007, GH implemented initiatives which substantially reduced daily opioid dose and increased patient monitoring. Among GH members age 18 or older receiving COT between 2006 and 2014, we compared injury rates for patients in GH's integrated group practice (IGP; exposed to the initiatives) vs patients cared for by contracted providers (not exposed). Injuries were identified using a validated algorithm. We calculated injury incidence during the baseline (preintervention) period from 2006 to 2007; the dose reduction period, 2008 to 2010; and the risk stratification and monitoring period, 2010 to 2014. Using modified Poisson regression, we estimated adjusted relative risks (RRs) representing the relative change per year in injury rates.
Among 21 853 people receiving COT in the IGP and 8260 in contracted care, there were 2679 injuries during follow-up. The baseline injury rate was 1.0% per calendar quarter in the IGP and 0.9% in contracted care. Risk reduction initiatives did not decrease injury rates: Within the IGP, the RR in the dose reduction period was 1.01 (95% CI, 0.95-1.07) and in the risk stratification and monitoring period, 0.99 (95% CI, 0.95-1.04). Injury trends did not differ between the two care settings.
Risk reduction initiatives did not decrease injuries in people using COT.
本研究旨在确定改善阿片类药物处方安全性的举措是否降低了慢性阿片类药物治疗（COT）患者的伤害。
我们使用来自美国综合医疗服务提供系统 Group Health（GH）的数据进行了一项中断时间序列分析。2007 年，GH 实施了一系列举措，大幅降低了阿片类药物的日剂量并增加了患者监测。在 2006 年至 2014 年期间接受 COT 的 GH 年龄在 18 岁及以上的成员中，我们比较了 GH 综合实践组（IGP；接触到这些举措）患者和由签约提供者（未接触）治疗的患者的伤害发生率。使用验证算法确定伤害。我们在基线（干预前）期（2006 年至 2007 年）、剂量减少期（2008 年至 2010 年）和风险分层及监测期（2010 年至 2014 年）计算伤害发生率。采用校正 Poisson 回归，我们估计了代表伤害率每年相对变化的调整相对风险（RR）。
在接受 IGP 中 COT 治疗的 21853 人和接受签约护理的 8260 人中，随访期间发生了 2679 例伤害。IGP 中的基线伤害率为每季度 1.0%，签约护理中为 0.9%。风险降低举措并未降低伤害率：在 IGP 中，剂量减少期的 RR 为 1.01（95%CI，0.95-1.07），风险分层和监测期的 RR 为 0.99（95%CI，0.95-1.04）。两种护理环境中的伤害趋势没有差异。
降低风险的举措并未降低接受 COT 治疗的患者的伤害。
