Department of Family Medicine, Oregon Health & Science University, Portland.
OCHIN Inc, Portland, Oregon.
JAMA Netw Open. 2020 Sep 1;3(9):e2013431. doi: 10.1001/jamanetworkopen.2020.13431.
Understanding opioid prescribing patterns in community health centers (CHCs) that disproportionately serve low-income patients may help to guide strategies to reduce opioid-related harms.
To assess opioid prescribing patterns between January 1, 2009, and December 31, 2018, in a network of safety-net clinics serving high-risk patients.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 3 227 459 opioid prescriptions abstracted from the electronic health records of 2 129 097 unique primary care patients treated from 2009 through 2018 at a network of CHCs that included 449 clinic sites in 17 states. All age groups were included in the analysis.
The following measures were described at the population level for each study year: (1) percentage of patients with at least 1 prescription for an opioid by age and sex, (2) number of opioid prescriptions per 100 patients, (3) number of long-acting opioid prescriptions per 100 patients, (4) mean annual morphine milligram equivalents (MMEs) per patient, (5) mean MME per prescription, (6) number of chronic opioid users, and (7) mean of high-dose opioid users.
The study population included 2 129 097 patients (1 158 413 women [54.4%]) with a mean (SD) age of 32.2 (21.1) years and a total of 3 227 459 opioid prescriptions. The percentage of patients receiving at least 1 opioid prescription in a calendar year declined 67.4% from 15.9% in 2009 to 5.2% in 2018. Over the 10-year study period, a greater percentage of women received a prescription (13.1%) compared with men (10.9%), and a greater percentage of non-Hispanic White patients (18.1%) received an opioid prescription compared with non-Hispanic Black patients (9.5%), non-Hispanic patients who self-identified as other races (8.0%), and Hispanic patients (6.9%). The number of opioid prescriptions for every 100 patients decreased 73.7% from 110.8 in 2009 to 29.1 in 2018. The number of long-acting opioids for every 100 patients decreased 85.5% during the same period, from 22.0 to 3.2. The MMEs per patient decreased from 1682.7 in 2009 to 243.1 in 2018, a decline of 85.6%.
In this cross-sectional study, the opioid prescribing rate in 2009 in the CHC network was higher than national population estimates but began to decline earlier and more precipitously. This finding likely reflects harm mitigation policies and efforts at federal, state, and clinic levels and strong clinical quality improvement strategies within the CHCs.
了解在服务低收入患者的社区卫生中心（CHC）中开具阿片类药物的模式，可能有助于指导减少阿片类相关危害的策略。
评估在 2009 年 1 月 1 日至 2018 年 12 月 31 日期间，在一个为高风险患者服务的安全网诊所网络中，观察阿片类药物的开具模式。
设计、地点和参与者：对来自 2009 年至 2018 年间在包括 17 个州的 449 个诊所站点的 CHC 网络中接受治疗的 2129097 名接受初级保健的独特患者的电子健康记录中抽取的 3227459 份阿片类药物处方进行的横截面研究。所有年龄组均纳入分析。
在每个研究年份，以人群水平描述了以下措施：（1）每个年龄段至少有 1 份阿片类药物处方的患者比例（按年龄和性别），（2）每 100 名患者的阿片类药物处方数，（3）每 100 名患者的长效阿片类药物处方数，（4）每位患者每年的平均吗啡毫克当量（MME），（5）每位患者的平均 MME 处方数，（6）慢性阿片类药物使用者的数量，（7）高剂量阿片类药物使用者的平均值。
研究人群包括 2129097 名患者（1158413 名女性[54.4%]），平均（SD）年龄为 32.2（21.1）岁，总共有 3227459 份阿片类药物处方。在一个日历年内，至少有 1 份阿片类药物处方的患者比例从 2009 年的 15.9%下降到 2018 年的 5.2%，下降了 67.4%。在 10 年的研究期间，接受处方的女性（13.1%）比例高于男性（10.9%），而非西班牙裔白人患者（18.1%）接受阿片类药物处方的比例高于非西班牙裔黑人患者（9.5%）、自我认定为其他种族的非西班牙裔患者（8.0%）和西班牙裔患者（6.9%）。每 100 名患者的阿片类药物处方数量从 2009 年的 110.8 份下降到 2018 年的 29.1 份，下降了 73.7%。同期，每 100 名患者的长效阿片类药物处方数量从 22.0 份下降到 3.2 份，下降了 85.5%。每位患者的 MME 从 2009 年的 1682.7 毫克下降到 2018 年的 243.1 毫克，下降了 85.6%。
在这项横截面研究中，2009 年 CHC 网络中的阿片类药物处方率高于全国人口估计，但开始下降的时间更早，幅度更大。这一发现可能反映了联邦、州和诊所各级的减害政策和努力，以及 CHC 内部强大的临床质量改进策略。
