Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States.
Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States.
Drug Alcohol Depend. 2019 Apr 1;197:250-254. doi: 10.1016/j.drugalcdep.2019.01.012. Epub 2019 Feb 16.
Despite recent decreases in opioid prescribing rates, evidence suggests there is substantial variation in the way opioids are prescribed by providers. This study aims to identify patterns in high-volume opioid prescribing.
We conducted partitioning-around-medoids cluster analysis using the IQVIA Prescriber Profile dataset, including the number of opioid prescriptions filled at US retail pharmacies aggregated at the prescriber-level from July 2016 through June 2017. Clustering was used to identify prescription patterns within a sample of 10,000 high-volume opioid prescribers (defined as the top 10% of prescribers by number of opioid prescriptions during the 12-month period). Clustering variables included prescription counts by opioid type, and prescriber specialty, age, and region.
Family medicine (32%), internal medicine (23%), and orthopedics (11%) were the most common high-volume prescribing specialties. Across specialties, hydrocodone and oxycodone were the most-frequently prescribed opioid types. Thirty-five clusters of prescribers were obtained, consistently comprised of a single majority specialty and region. All majority high-prescribing specialties were represented in Southern clusters, indicating consistently high volume opioid prescribing across specialties in the region. Prescribing patterns varied by drug type and region - across every Northeastern cluster, oxycodone prescribing was higher than hydrocodone. While clusters of pain medicine specialists had the highest median total prescriptions, emergency medicine specialist clusters had some of the lowest.
These results provide a clearer picture of current patterns among high-volume prescribers, who accounted for almost two-thirds of all opioid prescriptions. In light of the ongoing opioid overdose epidemic, this knowledge is critical for prevention activities.
尽管阿片类药物处方率最近有所下降，但有证据表明，提供者开具阿片类药物的方式存在很大差异。本研究旨在确定大量开阿片类药物的模式。
我们使用 IQVIA 开方者档案数据集进行了基于中位数的分区聚类分析，该数据集包括 2016 年 7 月至 2017 年 6 月期间按开方者汇总的美国零售药店中阿片类药物处方的数量。聚类用于识别 10000 名大量开阿片类药物的开方者（按 12 个月期间阿片类药物处方数量排名前 10%的开方者定义）样本中的处方模式。聚类变量包括按阿片类药物类型和开方者专业、年龄和地区划分的处方数量。
家庭医学（32%）、内科（23%）和骨科（11%）是最常见的大量开方专业。在所有专业中，氢可酮和羟考酮是最常开的阿片类药物类型。共获得 35 个开方者聚类，始终由单一的主要专业和地区组成。所有主要的高处方专业都出现在南部聚类中，表明该地区各专业的阿片类药物处方量一直很高。开方模式因药物类型和地区而异——在每个东北部聚类中，羟考酮的处方量都高于氢可酮。虽然疼痛医学专家聚类的总处方中位数最高，但急诊医学专家聚类的处方中位数最低。
这些结果更清楚地描绘了大量开方者的当前模式，他们占所有阿片类药物处方的近三分之二。鉴于阿片类药物过量流行的持续存在，这些知识对于预防活动至关重要。
