Division of Pediatric Hematology/Oncology/BMT, Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA.
Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA.
Pain Med. 2020 Oct 1;21(10):2583-2592. doi: 10.1093/pm/pnaa002.
To assess the impact of Ohio's 2012, 2013, and 2016 opioid prescribing guidelines on opioid and nonsteroidal anti-inflammatory drug (NSAID) prescription filling and health care utilization for pain among children with sickle cell disease (SCD).
Quasi-experimental retrospective cohort study.
Ohio Medicaid claims data from August 2011 to August 2016.
Medicaid beneficiaries under age 19 years with SCD.
Interrupted time series analyses comparing population-level rates of opioids and NSAID prescriptions filled, standardized amounts of opioids dispensed, and acute health care utilization for pain before and after release of each guideline.
In our cohort of 1,505 children with SCD, there was a temporary but significant decrease in the opioid filling rate (-2.96 prescriptions per 100 children, P = 0.01) and in the amount of opioids dispensed (-31.39 milligram morphine equivalents per filled prescription, P < 0.001) after the 2013 guideline but a temporary but significant increase in the opioid filling rate (7.44 prescriptions per 100 children, P < 0.001) and in the amount of opioids dispensed (72.73 mg morphine equivalents per filled prescription, P < 0.001) after the 2016 guideline. The NSAID filling rate did not significantly change after any of the guidelines. Acute health care utilization rates for pain after the 2016 guideline were similar to those before the 2013 guideline (rate ratio = 1.04, P = 0.63).
Our results suggest that Ohio's 2013 and 2016 guidelines were associated with significant but nonsustained changes in opioid prescription filling among children with SCD. Additional studies are needed to confirm that opioid guidelines have a sustained impact on excessive opioid prescribing, filling, and misuse.
评估俄亥俄州 2012 年、2013 年和 2016 年阿片类药物处方指南对镰状细胞病（SCD）儿童阿片类药物和非甾体抗炎药（NSAID）处方填写以及疼痛相关医疗保健利用的影响。
准实验回顾性队列研究。
俄亥俄州医疗补助索赔数据，2011 年 8 月至 2016 年 8 月。
年龄在 19 岁以下、患有 SCD 的医疗补助受益人。
使用中断时间序列分析，在指南发布前后比较人群中阿片类药物和 NSAID 处方的填写率、分配的阿片类药物标准化量以及疼痛相关的急性医疗保健利用率。
在我们的 1505 名患有 SCD 的儿童队列中，在 2013 年指南发布后，阿片类药物的填充率（每 100 名儿童减少 2.96 个处方，P=0.01）和分配的阿片类药物量（每 1 个处方减少 31.39 毫克吗啡当量，P<0.001）均出现暂时但显著的下降，但在 2016 年指南发布后，阿片类药物的填充率（每 100 名儿童增加 7.44 个处方，P<0.001）和分配的阿片类药物量（每 1 个处方增加 72.73 毫克吗啡当量，P<0.001）出现暂时但显著的增加。任何指南发布后，NSAID 的填充率均无显著变化。在 2016 年指南发布后，疼痛相关的急性医疗保健利用率与 2013 年指南发布前相似（率比=1.04，P=0.63）。
我们的研究结果表明，俄亥俄州的 2013 年和 2016 年指南与 SCD 儿童阿片类药物处方填写的显著但非持续变化相关。需要进一步研究以证实阿片类药物指南对过度开具、填写和滥用阿片类药物有持续影响。
