阿片类药物指南的实施对阿片类药物处方、不良后果以及与州阿片类相关死亡的关联有影响。
Implementation of an Opioid Guideline Impacts on Opioid Prescriptions, Adverse Outcomes, and an Association with a State Opioid-Related Fatalities.
机构信息
Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, Utah (Drs Phillips, Thiese, Hegmann); and Mitchell International, San Diego, California (Freeman, Kartchner).
出版信息
J Occup Environ Med. 2019 Aug;61(8):653-658. doi: 10.1097/JOM.0000000000001640.
OBJECTIVE
The aim of this study was to determine the efficacy of an evidence-based opioid guidelines-based program implemented at the largest worker's compensation insurer in Utah.
METHODS
All new claims, including surgeries, were included. Pre- and post-intervention comparisons included percentage of claims treated with an opioid, provision of a second opioid prescription, opioid use above 50 mg morphine equivalent dose (MED), opioid use more than 90 mg MED, and opioid use over 90 days.
RESULTS
There were significant (P < 0.001) reductions in all primary outcomes, with a reduction in MEDs in the 18 months after implementation totaling 65,502 mg.
CONCLUSION
This program significantly reduced the usage of opioids among acute claims. The year of program implementation, Utah experienced a 19.8% reduction in opioid-related fatalities, which may be partly related to the reduction in MEDs. Regardless, this study suggests that the implementation of an evidence-based guideline is impactful and feasible.
目的
本研究旨在确定在犹他州最大的工人赔偿保险公司实施的基于循证阿片类药物指南的项目的疗效。
方法
所有新的索赔申请，包括手术治疗，均包含在内。干预前后的比较包括接受阿片类药物治疗的索赔比例、提供第二种阿片类药物处方、阿片类药物使用量超过 50mg 吗啡等效剂量（MED）、阿片类药物使用量超过 90mg MED 和阿片类药物使用时间超过 90 天。
结果
所有主要结果均有显著（P < 0.001）降低，实施后 18 个月 MED 总降低量为 65502mg。
结论
该项目显著减少了急性索赔中阿片类药物的使用。在实施该项目的那一年，犹他州的阿片类药物相关死亡人数减少了 19.8%，这可能部分与 MED 的降低有关。无论如何，本研究表明，实施循证指南是有影响且可行的。
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