Department of Radiation Oncology, University of North Carolina at Chapel Hill.
Department of Population Health, University of Kansas Medical Center, Kansas City.
JAMA Oncol. 2020 Aug 1;6(8):1271-1274. doi: 10.1001/jamaoncol.2020.2211.
In response to the opioid epidemic, policies aiming to reduce opioid prescribing, misuse, and abuse may have the unintended consequence of restricting access to necessary opioid therapy for cancer-related pain. It is unknown how opioid prescribing patterns have changed among generalists and oncologists during this era.
To examine trends in opioid prescription rates for Medicare Part D beneficiaries from 2013 to 2017 among oncologists and generalists.
DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study of generalist physicians (internal medicine, family medicine, geriatric medicine, general practice) and oncology specialists (medical oncology, hematology-oncology, and radiation oncology) analyzed the Medicare Provider Utilization and Payment Data: Part D prescriber files from 2013 to 2017.
Generalist vs oncology specialty.
Outcomes included physician-level rates of both opioid and long-acting opioid prescriptions per 100 Medicare Part D beneficiaries. Poisson regression was used to estimate annual predicted outcome rates and incidence rate ratios, adjusting for prescriber characteristics and state fixed effects.
We analyzed the prescribing patterns of 251 820 generalists and 14 210 oncologists. From 2013 to 2017, the annual adjusted predicted mean rate of opioid prescriptions per 100 Medicare beneficiaries decreased from 68.2 to 49.7 among generalists (adjusted incidence rate ratio [aIRR] = 0.73; 95% CI, 0.73-0.73) and from 77.8 to 58.8 among oncologists (aIRR = 0.76; 95% CI, 0.74-0.77). The rate of long-acting opioid prescriptions per 100 Medicare beneficiaries also decreased from 8.0 to 5.4 for generalists (aIRR = 0.67; 95% CI, 0.66-0.68) and from 18.6 to 13.3 for oncologists (aIRR = 0.72; 95% CI, 0.69-0.74).
We found large declines in opioid prescription rates for Medicare beneficiaries by generalists and oncologists from 2013 to 2017. Opioid policy and advocacy appear to have been effective in reducing the extent of opioid prescribing in the Medicare population. Similar declines between generalists and oncologists raise concern that access to cancer pain management may have been inadvertently restricted. How much of the decrease in prescribing by oncologists is appropriate vs inappropriate deserves further investigation.
为应对阿片类药物流行，旨在减少阿片类药物处方、误用和滥用的政策可能会产生意想不到的后果，限制癌症相关疼痛的必要阿片类药物治疗的获取。在此期间，普通科医生和肿瘤学家的阿片类药物处方模式变化情况尚不清楚。
本研究旨在调查 2013 年至 2017 年间，普通科医生（内科、家庭医学、老年医学、全科医学）和肿瘤专家（肿瘤内科、血液肿瘤学-肿瘤学和放射肿瘤学）开具的医疗保险处方率趋势。
设计、地点和参与者：本项重复横断面研究纳入了 2013 年至 2017 年医疗保险提供者使用和支付数据：第 D 部分处方医生文件中的普通科医生（内科、家庭医学、老年医学、全科医学）和肿瘤学专家（肿瘤内科、血液肿瘤学-肿瘤学和放射肿瘤学）。
普通科医生与肿瘤学专业。
结果包括每 100 名医疗保险 D 部分受益人的医生级别阿片类药物和长效阿片类药物处方率。采用泊松回归估计每年预测的结果率和发病率比，并调整了医生特征和州固定效应。
我们分析了 251820 名普通科医生和 14210 名肿瘤学家的处方模式。2013 年至 2017 年间，每 100 名医疗保险受益人的阿片类药物年度调整预测平均处方率从普通科医生的 68.2 降至 49.7（调整后的发病率比[aIRR] = 0.73；95%CI，0.73-0.73），从肿瘤学家的 77.8 降至 58.8（aIRR = 0.76；95%CI，0.74-0.77）。每 100 名医疗保险受益人的长效阿片类药物处方率也从普通科医生的 8.0 降至 5.4（aIRR = 0.67；95%CI，0.66-0.68）和肿瘤学家的 18.6 降至 13.3（aIRR = 0.72；95%CI，0.69-0.74）。
我们发现，2013 年至 2017 年间，普通科医生和肿瘤学家为医疗保险受益人的阿片类药物处方率大幅下降。阿片类药物政策和宣传似乎有效地减少了医疗保险人群中阿片类药物的使用。普通科医生和肿瘤学家之间类似的下降令人担忧，因为癌症疼痛管理的获取可能无意中受到限制。肿瘤学家处方减少的程度中有多少是适当的，有多少是不适当的，这值得进一步调查。
