Patel Nisarg A, Keith David A
Graduate Student, Department of Biomedical Informatics, Harvard Medical School, and Broad Institute of MIT and Harvard, Cambridge, MA.
Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, and Harvard School of Dental Medicine, Harvard University, Boston, MA.
J Oral Maxillofac Surg. 2019 Dec;77(12):2439-2446. doi: 10.1016/j.joms.2019.07.004. Epub 2019 Jul 16.
To examine the volume and variation in opioid prescribing practices among oral and maxillofacial surgeons (OMSs) serving Medicare beneficiaries from 2013 to 2017 and identify the practice-level features that correlate with the opioid prescription volume.
The present cross-sectional study included Medicare Provider Utilization and Payment Data from 2013 to 2017. Providers were included if they were labelled as OMSs. The primary outcome variable was the opioid claim volume. The predictor variables included provider and beneficiary gender, beneficiary age, and beneficiary hierarchical condition category (HCC). The secondary outcome variables included mean opioid prescriptions per beneficiary and opioid days' supply per claim. Descriptive statistics and regression analyses were computed at an α level of 0.05.
The 5-year analysis cohort included 2071 distinct providers; 605,593 total opioid prescription claims were recorded for 516,217 Medicare beneficiaries, with an average supply of 3.54 days of opioids per patient. From 2013 to 2017, a significant increase had occurred in the number of mean opioid claims per provider (P < .001) and a significant decrease in both the mean opioid claims per beneficiary (P < .001) and the days' supply per opioid claim per beneficiary (P < .001). Male provider gender (P < .001), lower beneficiary age (P < .001), percentage of female beneficiaries seen by a provider (P < .001), and lower HCC risk score (P < .001) all correlated with an increased opioid claim volume. Finally, a significant difference was found in the opioid claim volume among OMSs between the states (P < .001) and between oral and maxillofacial surgery and other surgical subspecialties (P < .001).
Although the total number of opioids prescribed by OMSs has increased over time, the prescribing practices have, on the aggregate, become more responsible. The extreme cases of opioid prescribing and variations in state-level opioid claim volumes warrant additional investigation.
研究2013年至2017年为医疗保险受益人服务的口腔颌面外科医生（OMS）开具阿片类药物的数量及变化情况，并确定与阿片类药物处方量相关的执业水平特征。
本横断面研究纳入了2013年至2017年的医疗保险提供者利用和支付数据。若提供者被标记为OMS，则纳入研究。主要结局变量为阿片类药物索赔量。预测变量包括提供者和受益人的性别、受益人年龄以及受益人分层疾病类别（HCC）。次要结局变量包括每位受益人平均阿片类药物处方数和每次索赔的阿片类药物供应天数。描述性统计和回归分析在α水平为0.05时进行。
5年分析队列包括2071名不同的提供者；为516,217名医疗保险受益人记录了总计605,593份阿片类药物处方索赔，每位患者平均阿片类药物供应天数为3.54天。从2013年到2017年，每位提供者的平均阿片类药物索赔数量显著增加（P <.001），每位受益人平均阿片类药物索赔数量和每位受益人每次阿片类药物索赔的供应天数均显著减少（P <.001）。提供者为男性（P <.001）、受益人年龄较低（P <.001）、提供者诊治的女性受益人百分比（P <.001）以及较低的HCC风险评分（P <.001）均与阿片类药物索赔量增加相关。最后，在不同州的OMS之间（P <.001）以及口腔颌面外科与其他外科亚专业之间（P <.001），阿片类药物索赔量存在显著差异。
尽管随着时间的推移，OMS开具的阿片类药物总数有所增加，但总体而言，处方行为变得更加负责。阿片类药物处方的极端情况以及州级阿片类药物索赔量的差异值得进一步调查。
