MMWR Morb Mortal Wkly Rep. 2019 Jan 18;68(2):25-30. doi: 10.15585/mmwr.mm6802a1.
Drug overdose is the leading cause of unintentional injury-associated death in the United States. Among 70,237 fatal drug overdoses in 2017, prescription opioids were involved in 17,029 (24.2%) (1). Higher rates of opioid-related deaths have been recorded in nonmetropolitan (rural) areas (2). In 2017, 14 rural counties were among the 15 counties with the highest opioid prescribing rates.* Higher opioid prescribing rates put patients at risk for addiction and overdose (3). Using deidentified data from the Athenahealth electronic health record (EHR) system, opioid prescribing rates among 31,422 primary care providers in the United States were analyzed to evaluate trends from January 2014 to March 2017. This analysis assessed how prescribing practices varied among six urban-rural classification categories of counties, before and after the March 2016 release of CDC's Guideline for Prescribing Opioids for Chronic Pain (Guideline) (4). Patients in noncore (the most rural) counties had an 87% higher chance of receiving an opioid prescription compared with persons in large central metropolitan counties during the study period. Across all six county groups, the odds of receiving an opioid prescription decreased significantly after March 2016. This decrease followed a flat trend during the preceding period in micropolitan and large central metropolitan county groups; in contrast, the decrease continued previous downward trends in the other four county groups. Data from EHRs can effectively supplement traditional surveillance methods for monitoring trends in opioid prescribing and other areas of public health importance, with minimal lag time under ideal conditions. As less densely populated areas appear to indicate both substantial progress in decreasing opioid prescribing and ongoing need for reduction, community health care practices and intervention programs must continue to be tailored to community characteristics.
药物过量是导致美国非故意伤害相关死亡的主要原因。在 2017 年 70237 例致命药物过量中，处方类阿片药物涉及 17029 例（24.2%）（1）。在非大都市（农村）地区记录到更高的阿片类药物相关死亡率（2）。2017 年，14 个农村县位列 15 个阿片类药物处方率最高的县（3）。更高的阿片类药物处方率使患者面临成瘾和药物过量的风险（3）。本研究使用 Athenahealth 电子健康记录（EHR）系统的匿名数据，分析了美国 31422 名初级保健提供者的阿片类药物处方率，以评估 2014 年 1 月至 2017 年 3 月期间的趋势。该分析评估了在疾病预防控制中心发布《慢性疼痛阿片类药物处方指南》（Guideline）（4）前后，6 个城乡分类县的处方实践如何存在差异。与大中心大都市县的患者相比，在研究期间，非核心（最农村）县的患者接受阿片类药物处方的可能性高 87%。在所有 6 个县组中，2016 年 3 月后，接受阿片类药物处方的几率显著降低。这一下降趋势是在微都市和大中心大都市县组前期呈持平趋势之后出现的；相比之下，在其他四个县组中，下降趋势继续延续了以前的下降趋势。EHR 数据可以有效地补充传统监测方法，用于监测阿片类药物处方和其他公共卫生重点领域的趋势，在理想条件下，滞后时间极短。由于人口密度较低的地区似乎表明阿片类药物处方的减少取得了实质性进展，且仍有减少的需求，社区卫生保健实践和干预计划必须继续根据社区特点进行调整。
