Esposito Daina B, Cepeda M Soledad, Lyons Jennifer G, Yin Ruihua, Lanes Stephan
Department of Safety and Epidemiology, HealthCore, Inc, Wilmington, DE, USA.
Department of Research and Development, Janssen, Titusville, NJ, USA.
J Pain Res. 2019 Jul 24;12:2291-2303. doi: 10.2147/JPR.S203350. eCollection 2019.
Doctor/pharmacy shopping, the practice of seeking prescriptions from multiple healthcare sources without their coordination, may be a measure of prescription medicine abuse. This cross-sectional study examined the relationship between a claims-based doctor/pharmacy shopping definition and medical record documented behaviors suggestive of misuse, diversion, abuse and/or addiction.
Patients with ≥2 opioid dispensings starting in 2012 in a US administrative claims database were grouped into doctor/pharmacy shopping categories by number of providers and pharmacies used over 18 months: no shopping, minimal shopping, moderate shopping and severe shopping. Medical charts of opioid prescribers were reviewed to identify behaviors suggestive of misuse, diversion, abuse and/or addiction.
Among 581,940 opioid users, 78% were classified as no shopping, 11% minimal shopping, 8% moderate shopping and 3% severe shopping. Almost 40% of severe shopping patients had no medical record documented behaviors (positive predictive value: 24.3%). Compared with no shopping, the odds ratio [OR] of ≥3 behaviors was 1.70 (95% confidence interval [CI] 0.50-5.78) for minimal shopping, 1.81 (95% CI 0.54-6.03) for moderate shopping, and 8.93 (95% CI 3.12-25.54) for severe shopping.
Claims-identified severe doctor/pharmacy shopping was strongly associated with behaviors suggestive of misuse, diversion, abuse and/or addiction, but the proportion of medical records documenting these was low.
“医生/药房购物”行为，即不经过协调就从多个医疗保健机构获取处方的行为，可能是处方药滥用的一种表现。本横断面研究考察了基于索赔数据定义的“医生/药房购物”行为与病历记录中提示药物误用、转移、滥用和/或成瘾的行为之间的关系。
在美国一个行政索赔数据库中，将2012年起有≥2次阿片类药物配药记录的患者，按照18个月内使用的医疗服务提供者和药房数量，分为“非购物”“轻度购物”“中度购物”和“重度购物”几类。对阿片类药物处方医生的病历进行审查，以确定提示药物误用、转移、滥用和/或成瘾的行为。
在581,940名阿片类药物使用者中，78%被归类为非购物，11%为轻度购物，8%为中度购物，3%为重度购物。近40%的重度购物患者在病历中没有记录到相关行为（阳性预测值：24.3%）。与非购物患者相比，轻度购物患者出现≥3种行为的比值比（OR）为1.70（95%置信区间[CI]0.50 - 5.78），中度购物患者为1.81（95%CI 0.54 - 6.03），重度购物患者为8.93（95%CI 3.12 - 25.54）。
通过索赔数据确定的严重“医生/药房购物”行为与提示药物误用、转移、滥用和/或成瘾的行为密切相关，但病历记录中记录这些行为的比例较低。
