Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Am J Ind Med. 2019 Jan;62(1):21-29. doi: 10.1002/ajim.22920. Epub 2018 Nov 30.
The aim of this study was to examine adherence of state guidelines for Colorado workers' compensation physicians/providers treating individuals as injured workers with chronic pain after initiation of an opioid management program and provider incentives.
A retrospective cohort of chronic, non-cancer pain claims was constructed from the Colorado's workers' compensation database. Adherence to treatment guidelines and opioid prescribing practices were evaluated during implementation of a new billing code to incentivize adherence.
Overall, less than 33% of claims showed evidence of opioid management. Comprehensive opioid management was observed in only 4.4% of claims. In 2010, after implementing the new billing code, the ratio of long acting opioids to short acting opioids decreased from 0.2 to 0.13; returning to 0.2 in one year. Similarly, morphine equivalent doses declined for a short period.
Incentivizing physicians to adhere to chronic pain management guidelines only temporarily improves prescribing practices.
本研究旨在调查科罗拉多州工伤赔偿医生/提供者在实施阿片类药物管理方案和提供激励措施后，对治疗慢性疼痛的个体作为受伤工人的州指南的依从性。
从科罗拉多州工人赔偿数据库中构建了一组慢性非癌症疼痛的回顾性队列。在实施新计费代码以激励依从性的过程中，评估了治疗指南和阿片类药物处方实践的依从性。
总体而言，不到 33%的索赔显示出阿片类药物管理的证据。只有 4.4%的索赔显示出全面的阿片类药物管理。2010 年，在实施新计费代码后，长效阿片类药物与短效阿片类药物的比例从 0.2 降至 0.13；一年后又回升至 0.2。类似地，吗啡等效剂量在短时间内下降。
仅仅激励医生遵守慢性疼痛管理指南只能暂时改善处方实践。
