University of Michigan Medical School, Ann Arbor, MI.
Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
Surgery. 2020 Aug;168(2):244-252. doi: 10.1016/j.surg.2020.04.013. Epub 2020 Jun 4.
Models of health care coverage with varying degrees of patient cost-sharing have been shown to influence health care behaviors for chronic conditions including medication adherence. The effect of insurance cost-sharing subsidies on the probability of postoperative opioid refill, however, is unclear.
This retrospective cohort study examined 100% Medicare claims data among patients (N = 21,781) ages 65 and older undergoing orthopedic procedures in Michigan between January 2013 and September 2016. Patients were classified based on the presence of low-income subsidy and on prior opioid exposure using Medicare Part D prescription files of drug events. We investigated the association of these factors with the probability of both initial and second postoperative opioid fill within 90 days from the date of discharge.
In this cohort, 84.6% of patients filled an initial opioid prescription, and 66.4% refilled an opioid prescription. Patients with a full low-income subsidy had greater odds of refill within the postoperative 90 days compared with those patients without a low-income subsidy (odds ratio 1.38, 95% confidence interval 1.18-1.60). Among opioid naïve patients with a full low-income subsidy, the adjusted refill rate was 61.3% (95% confidence interval 58.0-64.7%) compared with 57.6% (95% confidence interval 51.4-63.7%) among those with partial low-income subsidy and 54.2% (95% confidence interval 52.8-55.6%) among patients without low-income subsidy.
Among Medicare patients undergoing orthopedic procedures, a full medication subsidy is associated with an increased probability of opioid refill when compared with no subsidy. Going forward, it is critical to lessen financial barriers to ensure all patients have equitable access to postoperative analgesia, including both opioid and nonopioid analgesics by decreasing the patient burden of cost-sharing.
具有不同程度患者自付费用的医疗保险覆盖模式已被证明会影响包括药物依从性在内的慢性病的医疗行为。然而，保险自付费用补贴对术后阿片类药物续用概率的影响尚不清楚。
本回顾性队列研究调查了 2013 年 1 月至 2016 年 9 月期间在密歇根州接受骨科手术的 21781 名 65 岁及以上的 Medicare 患者的 100%索赔数据。根据 Medicare Part D 药物事件处方档案，根据低收入补贴的存在和先前阿片类药物暴露情况，对患者进行分类。我们调查了这些因素与初始和第二次术后 90 天内阿片类药物填充概率的关系。
在该队列中，84.6%的患者填写了初始阿片类药物处方，66.4%的患者再次开了阿片类药物处方。与没有低收入补贴的患者相比，完全享受低收入补贴的患者在术后 90 天内续药的可能性更大（优势比 1.38，95%置信区间 1.18-1.60）。在完全享受低收入补贴的阿片类药物初治患者中，调整后的续药率为 61.3%（95%置信区间 58.0-64.7%），而部分享受低收入补贴的患者为 57.6%（95%置信区间 51.4-63.7%），没有享受低收入补贴的患者为 54.2%（95%置信区间 52.8-55.6%）。
在接受骨科手术的 Medicare 患者中，与没有补贴相比，全额药物补贴与阿片类药物续用的可能性增加相关。今后，通过降低患者的自付费用负担，减少获取术后镇痛的经济障碍至关重要，包括减少阿片类药物和非阿片类药物的患者负担，以确保所有患者都能公平获得阿片类药物和非阿片类药物的镇痛。
