MedImpact Healthcare Systems, San Diego, California.
J Manag Care Spec Pharm. 2020 Feb;26(2):160-167. doi: 10.18553/jmcp.2020.26.2.160.
Concurrent use of opioids and benzodiazepines (COB) can lead to additive respiratory and central nervous system effects, putting patients at increased risk of fatal overdose. In 2016, the Centers for Disease Control and Prevention released an opioid-prescribing guideline recommending against COB, and the Pharmacy Quality Alliance (PQA) endorsed a COB measure in its core opioid set. From May 1, 2017, to December 4, 2017, a California Medicaid plan launched a COB-focused prescriber outreach intervention for members receiving recent opioid and benzodiazepine claims with the intent of decreasing concurrent use.
To assess the effect of a prescriber fax intervention by a Medicaid plan on COB.
Two retrospective analyses were conducted using administrative pharmacy claims data: a comparison of the PQA COB rate among selected California Medicaid plans for 2016 and 2017 and a cohort utilization analysis of members identified for the fax intervention compared with controls. Intervention and control members were matched based on 12 pre-index utilization characteristics. Outcomes assessed included proportion of members with resolution of COB in the post-index period, change in mean number of COB days before and after the index date, and proportion of members with decreased benzodiazepine daily dose after the index date. Analyses were also performed for the subgroups of members with < 30 days of COB and ≥ 30 days of COB in the pre-index period.
All California Medicaid plans in the study saw an improvement in the PQA COB rate between 2016 and 2017. In the utilization analysis, 4,182 intervention members were eligible according to study criteria and matched to similar control members. Many differences in medication use existed between the subgroups with < 30 days and ≥ 30 days of COB in the pre-index period, with the latter group consisting of much more chronic, complex users. The intervention cohort had a statistically significant higher proportion of members with complete resolution of COB compared with the control cohort (43.8% vs. 40.0%; < 0.01), which was also statistically significant for the 2 subgroups. The intervention cohort had a decrease in the mean number of COB days from pre- to post-index periods, but this was only statistically significant for the subgroup with < 30 COB days (-2.5 vs. -1.5; = 0.0217). No statistically significant differences were detected between cohorts in proportion of members with decreased benzodiazepine dose.
Our analyses demonstrated that this low-touch prescriber fax intervention produced statistically significant improvements in COB outcomes, despite the overall trend of declining COB among the other California Medicaid plans. Low-touch, targeted prescriber outreach can be an inexpensive yet effective tool to affect prescriber behavior, particularly before COB becomes chronic.
No outside funding was used to support this study. The authors do not have any financial relationships or potential conflicts of interest relevant to this article to disclose. At the time of conducting this research, all authors were employees of MedImpact Healthcare Systems. The results of this study were presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2019; March 25-28, 2019; San Diego, CA.
阿片类药物和苯二氮䓬类药物（COB）的同时使用会导致呼吸和中枢神经系统的附加作用，使患者面临致命药物过量的风险增加。2016 年，疾病控制和预防中心发布了阿片类药物处方指南，建议避免 COB，药房质量联盟（PQA）在其核心阿片类药物集中认可了 COB 措施。从 2017 年 5 月 1 日至 2017 年 12 月 4 日，加利福尼亚州医疗补助计划针对最近接受阿片类药物和苯二氮䓬类药物索赔的成员发起了一项以 COB 为重点的处方医生外展干预措施，目的是减少同时使用。
评估医疗补助计划的处方医生传真干预对 COB 的影响。
使用行政药房索赔数据进行了两项回顾性分析：比较选定的加利福尼亚医疗补助计划在 2016 年和 2017 年的 PQA COB 率，以及对符合传真干预条件的成员进行队列利用分析与对照组进行比较。干预和对照组成员根据 12 项指数前使用特征进行匹配。评估的结果包括在后索引期内 COB 得到解决的成员比例，在索引日期前后 COB 天数的平均变化，以及在索引日期后减少苯二氮䓬类药物日剂量的成员比例。还针对前索引期内 COB 天数<30 天和≥30 天的亚组进行了分析。
研究中的所有加利福尼亚医疗补助计划都在 2016 年至 2017 年期间看到了 PQA COB 率的改善。在利用分析中，根据研究标准，有 4182 名干预成员符合条件，并与类似的对照组成员相匹配。在指数前有<30 天和≥30 天 COB 的亚组之间存在许多药物使用差异，后者组的慢性、复杂患者比例更高。与对照组相比，干预组中有更高比例的成员完全解决了 COB（43.8%对 40.0%；<0.01），这在两个亚组中也是统计学上显著的。干预组从指数前到指数后期间的 COB 天数平均减少，但对于 COB 天数<30 天的亚组，这仅具有统计学意义（-2.5 对-1.5；=0.0217）。在减少苯二氮䓬类药物剂量的成员比例方面，两个队列之间没有检测到统计学显著差异。
我们的分析表明，尽管加利福尼亚州其他医疗补助计划的 COB 总体呈下降趋势，但这种低接触的处方医生传真干预在 COB 结果方面产生了统计学上显著的改善。低接触、有针对性的处方医生外展可以成为一种廉价但有效的工具来影响处方医生的行为，特别是在 COB 变得慢性之前。
没有使用外部资金来支持这项研究。作者与本研究没有任何相关的财务关系或潜在的利益冲突需要披露。在进行这项研究时，所有作者都是 MedImpact Healthcare Systems 的员工。这项研究的结果在 2019 年 AMCP 管理式医疗和特种药房年会（2019 年 3 月 25-28 日，圣地亚哥，CA）上进行了介绍。
