Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
Department of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina.
J Rural Health. 2020 Mar;36(2):145-151. doi: 10.1111/jrh.12386. Epub 2019 Aug 6.
This study compared rural to nonrural dentists with respect to opioid prescribing practices, perceptions about prescription drug abuse among patients, and training relevant to pain management and addictions.
A web-based, cross-sectional questionnaire was administered to practicing dentist members of the National Dental Practice-Based Research Network (PBRN; N = 822) and linked with network enrollment questionnaire data regarding practitioner demographics and practice characteristics. Pain management prescribing practices and perceptions regarding relevance and scope of addiction and drug diversion among patients were assessed. Rural practice was defined as a practice whose ZIP Code has more than 50% of its population in either a nonmetropolitan county and/or a rural Census tract.
Rural dentists were significantly more likely than their nonrural counterparts to recommend nonsteroidal anti-inflammatory agents/acetaminophen in combination with prescribing an opioid [F (1,820) = 4.59, P = .03]. Compared to nonrural dentists, rural dentists were more likely to report that opioid abuse/diversion was a problem in their practices [χ [1, n = 807] = 6.85, P < .001], were more likely to have suspected a patient of abuse or diversion [χ [1, n = 807] = 10.12, P = .001], and were more likely to have refrained from prescribing due to suspicions of abuse or diversion [χ [1, n = 807] = 12.49, P < .001].
Rural dentists may be disproportionately impacted by patients' opioid abuse and represent a viable target for educational outreach that encourages screening, identification, and referral of patients in need of drug abuse treatment.
本研究比较了农村和非农村牙医在开阿片类药物处方的做法、对患者处方药物滥用的看法，以及与疼痛管理和成瘾相关的培训方面的差异。
通过网络向全国牙科实践基础研究网络（PBRN）的执业牙医成员（N=822）发放了一份基于横断面的问卷，并与网络登记问卷数据相关联，这些数据涉及从业者的人口统计学和实践特征。评估了疼痛管理处方实践，以及对患者成瘾和药物转移相关的相关性和范围的看法。农村实践的定义是其邮政编码中超过 50%的人口位于非城市县和/或农村人口普查区的实践。
农村牙医比非农村牙医更有可能推荐非甾体抗炎药/对乙酰氨基酚联合开阿片类药物处方[F（1,820）=4.59，P=0.03]。与非农村牙医相比，农村牙医更有可能报告阿片类药物滥用/转移是他们实践中的一个问题[χ[1，n=807]=6.85，P<.001]，更有可能怀疑患者有滥用或转移的行为[χ[1，n=807]=10.12，P=0.001]，并且更有可能因为怀疑滥用或转移而避免开处方[χ[1，n=807]=12.49，P<.001]。
农村牙医可能受到患者阿片类药物滥用的不成比例的影响，他们是教育外展的一个可行目标，可以鼓励对需要药物滥用治疗的患者进行筛查、识别和转介。
