David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Department of Radiation Oncology, University of California, Los Angeles, CA, USA.
Cancer Med. 2020 May;9(10):3297-3304. doi: 10.1002/cam4.2907. Epub 2020 Mar 13.
Radiation oncologists (ROs) play an important role in managing cancer pain; however, their opioid prescribing patterns remain poorly described.
The 2016 Medicare Physician Compare National Downloadable and the 2016 Medicare Part D Prescriber Data files were cross-linked to identify RO-written opioid prescriptions.
Of 4,627 identified ROs, 1,360 (29.3%) wrote >10 opioid prescriptions. The average number of opioid prescriptions written was significantly (P ≤ .05) associated with the following RO characteristics: sex [13.1 ± 36.5 male vs 7.5 ± 16.9 female]; years since medical school graduation [4.5 ± 11.5 1-10 years vs 12.6 ± 26.0 11-24 years vs 13.3 ± 40.9 ≥25 years]; practice size [15.5 ± 44.6 size ≤10 vs 13.3 ± 25.9 size 11-49 vs 8.5 ± 12.7 size 50-99 vs 8.8 ± 26.9 size ≥100]; Medicare Physician Quality Reporting System (PQRS) participation [12.6 ± 31.8 yes vs 7.0 ± 35.4 no]; and practice location [17.4 ± 47.0 South vs 10.6 ± 29.4 Midwest vs 8.1 ± 13.9 West vs 6.9 ± 15.2 Northeast]. On multivariable regression modeling, male sex (RR 1.29, 95% CI 1.22-1.35, P < .001), ≥25 years since graduation (RR 0.78, 95% CI 0.64-0.70, 1-10 years vs ≥25 years; RR 1.00, 95% CI 0.96 - 1.04, 11-24 years vs ≥25 years; P < .001), practice size <10 members (RR 1.51, CI 1.44-1.59, ≤10 vs ≥100 members, RR 1.27, CI 1.20-1.34, 10-49 vs ≥100 members, RR 0.86, CI 0.80-0.92, 50-99 vs ≥100 members, P < .001), PQRS participation (RR 1.12, CI 1.04-1.19, P < .002), and Southern location (RR 0.67, CI 0.64-0.70, Midwest vs South; RR 0.39, CI 0.37-0.41, Northeast vs South; RR 0.43, CI 0.41-0.46, West vs South; P < .001) were predictive of higher opioid prescription rates.
Factors associated with increased number of RO-written opioid prescriptions were male sex, ≥25 years since graduation, group practice <10, PQRS participation, and Southern location. Additional research is required to establish optimal opioid prescribing practices for ROs.
放射肿瘤学家（RO）在管理癌症疼痛方面发挥着重要作用；然而，他们的阿片类药物处方模式仍描述不足。
将 2016 年医疗保险医师比较国家可下载文件和 2016 年医疗保险部分 D 处方数据文件进行交叉链接，以确定 RO 开具的阿片类药物处方。
在确定的 4627 名 RO 中，有 1360 名（29.3%）开具了>10 张阿片类药物处方。开具的阿片类药物处方数量与以下 RO 特征显著相关（P≤.05）：性别[男性 13.1±36.5 与女性 7.5±16.9]；医学院毕业年限[1-10 年 4.5±11.5 与 11-24 年 12.6±26.0 与≥25 年 13.3±40.9]；执业规模[≤10 名 15.5±44.6 与 11-49 名 13.3±25.9 与 50-99 名 8.5±12.7 与≥100 名 8.8±26.9]；参与医疗保险医师质量报告系统（PQRS）[是 12.6±31.8 与 否 7.0±35.4]；以及执业地点[南 17.4±47.0 与中西部 10.6±29.4 与西部 8.1±13.9 与东北部 6.9±15.2]。多变量回归模型分析显示，男性（RR 1.29，95%CI 1.22-1.35，P<.001）、≥25 年医学院毕业（RR 0.78，95%CI 0.64-0.70，1-10 年与≥25 年；RR 1.00，95%CI 0.96-1.04，11-24 年与≥25 年，P<.001）、执业规模<10 名（RR 1.51，CI 1.44-1.59，≤10 名与≥100 名，RR 1.27，CI 1.20-1.34，10-49 名与≥100 名，RR 0.86，CI 0.80-0.92，50-99 名与≥100 名，P<.001）、参与 PQRS（RR 1.12，CI 1.04-1.19，P<.002）和南部地点（RR 0.67，CI 0.64-0.70，中西部与南部；RR 0.39，CI 0.37-0.41，东北部与南部；RR 0.43，CI 0.41-0.46，西部与南部，P<.001）与 RO 开具的阿片类药物处方数量较高相关。
与 RO 开具的阿片类药物处方数量增加相关的因素包括男性、≥25 年医学院毕业、<10 人的团体执业、参与 PQRS 和南部地区。需要进一步研究以确定 RO 开具阿片类药物的最佳处方实践。
