Warrington Jill S, Lovejoy Nick, Brandon Jamie, Lavoie Keith, Powell Chris
Aspenti Health, South Burlington, VT, USA.
Robert Larner School of Medicine, University of Vermont Health Network, Burlington, VT, USA.
Acad Pathol. 2019 Oct 30;6:2374289519884877. doi: 10.1177/2374289519884877. eCollection 2019 Jan-Dec.
As the opioid crisis continues to have devastating consequences for our communities, families, and patients, innovative approaches are necessary to augment clinical care and the management of patients with opioid use disorders. As stewards of health analytic data, laboratories are uniquely poised to approach the opioid crisis differently. With this pilot study, we aimed to bridge laboratory data with social determinants of health data, which are known to influence morbidity and mortality of patients with substance use disorders. For the purpose of this pilot study, we focused on the co-use of opioids and benzodiazepines, which can lead to an increased risk of fatal opioid-related overdoses and increased utilization of acute care. Using the laboratory finding of the copresence of benzodiazepines and opioids as the primary outcome measure, we examined social determinants of health attributes that predict co-use. We found that the provider practice that ordered the laboratory result is the primary predictor of co-use. Increasing age was also predictive of co-use. Further, co-use is highly prevalent in specific geographic areas or "hotspots." The prominent geographic distribution of co-use suggests that targeted educational initiatives may benefit the communities in which co-use is prevalent. This study exemplifies the Clinical Lab 2.0 approach by leveraging laboratory data to gain insights into the overall health of the patient.
由于阿片类药物危机继续对我们的社区、家庭和患者造成毁灭性后果,因此需要创新方法来加强临床护理和对阿片类药物使用障碍患者的管理。作为健康分析数据的管理者,实验室在以不同方式应对阿片类药物危机方面具有独特的优势。通过这项试点研究,我们旨在将实验室数据与健康数据的社会决定因素联系起来,已知这些因素会影响物质使用障碍患者的发病率和死亡率。在这项试点研究中,我们重点关注阿片类药物和苯二氮卓类药物的共同使用,这可能会增加与阿片类药物相关的致命过量用药风险,并增加急性护理的利用率。以实验室检测到苯二氮卓类药物和阿片类药物同时存在为主要结局指标,我们研究了预测共同使用情况的健康属性的社会决定因素。我们发现,开具实验室检测结果的医疗服务提供者的行为是共同使用的主要预测因素。年龄增长也与共同使用有关。此外,共同使用在特定地理区域或“热点地区”非常普遍。共同使用的显著地理分布表明,有针对性的教育举措可能会使共同使用普遍的社区受益。这项研究通过利用实验室数据来深入了解患者的整体健康状况,例证了临床实验室2.0方法。