种族和保险类型均可独立预测癌症门诊患者口服阿片类药物的处方选择。
Both Race and Insurance Type Independently Predict the Selection of Oral Opioids Prescribed to Cancer Outpatients.
作者信息
Meghani Salimah H, Rosa William E, Chittams Jesse, Vallerand April Hazard, Bao Ting, Mao Jun J
机构信息
Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania; NewCourtland Center for Transitions and Health, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Pain Manag Nurs. 2020 Feb;21(1):65-71. doi: 10.1016/j.pmn.2019.07.004. Epub 2019 Sep 6.
BACKGROUND
Previous research suggests that racial disparities in patients' reported analgesic adverse effects are partially mediated by the type of opioid prescribed to African Americans despite the presence of certain comorbidities, such as renal disease.
AIMS
We aimed to identify independent predictors of the type of opioid prescribed to cancer outpatients and determine if race and chronic kidney disease independently predict prescription type, adjusting for relevant sociodemographic and clinical confounders.
DESIGN
We conducted a secondary analysis of a 3-month observational study.
SETTING
Outpatient oncology clinics of an academic medical center.
PARTICIPANTS/SUBJECTS: Patients were older than 18 years of age, self-identified as African American or White, and had an analgesic prescription for cancer pain.
METHODS
Cancer patients (N = 241) were recruited from outpatient oncology clinics within a large mid-Atlantic healthcare system.
RESULTS
Consistent with published literature, most patients (75.5%) were prescribed either morphine or oxycodone preparations as oral opioid therapy for cancer pain. When compared with Whites, African Americans were significantly more likely to be prescribed morphine (33% vs 14%) and less likely to be prescribed oxycodone (38% vs 64%) (p < .001). The estimated odds for African Americans to receive morphine were 2.573 times that for Whites (95% confidence interval 1.077-6.134) after controlling for insurance type, income, and pain levels. In addition, the presence of private health insurance was negatively associated with the prescription of morphine and positively associated with prescription of oxycodone in separate multivariable models. The presence of chronic kidney disease did not predict type of analgesic prescribed.
CONCLUSIONS
Both race and insurance type independently predict type of opioid selection for cancer outpatients. Larger clinical studies are needed to fully understand the sources and clinical consequences of racial differences in opioid selection for cancer pain.
背景
先前的研究表明，尽管存在某些合并症，如肾病，但患者报告的镇痛不良反应中的种族差异部分是由给非裔美国人开具的阿片类药物类型介导的。
目的
我们旨在确定癌症门诊患者阿片类药物处方类型的独立预测因素，并确定种族和慢性肾病是否能独立预测处方类型，同时对相关的社会人口学和临床混杂因素进行调整。
设计
我们对一项为期3个月的观察性研究进行了二次分析。
地点
一所学术医疗中心的门诊肿瘤诊所。
参与者/受试者：患者年龄超过18岁，自我认定为非裔美国人或白人，且有癌症疼痛的镇痛处方。
方法
从大西洋中部一个大型医疗保健系统的门诊肿瘤诊所招募癌症患者（N = 241）。
结果
与已发表的文献一致，大多数患者（75.5%）被开具吗啡或羟考酮制剂作为癌症疼痛的口服阿片类药物治疗。与白人相比，非裔美国人被开具吗啡的可能性显著更高（33%对14%），而被开具羟考酮的可能性更低（38%对64%）（p <.001）。在控制保险类型、收入和疼痛水平后，非裔美国人接受吗啡的估计几率是白人的2.573倍（95%置信区间1.077 - 6.134）。此外，在单独的多变量模型中，拥有私人医疗保险与吗啡处方呈负相关，与羟考酮处方呈正相关。慢性肾病的存在并不能预测所开具的镇痛药物类型。
结论
种族和保险类型均能独立预测癌症门诊患者阿片类药物的选择类型。需要开展更大规模的临床研究，以充分了解癌症疼痛阿片类药物选择中种族差异的来源及临床后果。
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