Morasco Benjamin J, Smith Ning, Dobscha Steven K, Deyo Richard A, Hyde Stephanie, Yarborough Bobbi Jo
Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D99), Portland, OR, USA.
Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
J Gen Intern Med. 2020 Dec;35(Suppl 3):895-902. doi: 10.1007/s11606-020-06250-x. Epub 2020 Nov 3.
Prior research has identified factors associated with prescription opioid initiation, but little is known about the prevalence or predictors of dose escalation among patients already prescribed long-term opioid therapy (LTOT).
This was a 2-year prospective cohort study to examine patient and clinician factors associated with opioid dose escalation.
A prospective cohort study. Participants were seen at baseline and every 6 months for a total of 2 years.
Patients prescribed a stable dose of LTOT for musculoskeletal pain were recruited from two integrated health systems (Kaiser Permanente and the Department of Veterans Affairs, respectively).
The prescription opioid dose was based on pharmacy records and self-report. Administrative data were gathered on characteristics of the opioid-prescribing clinician and healthcare utilization. Participants completed measures of pain, functioning, and quality of life.
Of enrolled participants (n = 517), 19.5% had an opioid dose increase. In multivariate analyses, patient variables associated with dose escalation were lower opioid dose (hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.79-0.94, for every 10-mg increase in baseline dose) and greater pain catastrophizing (HR = 1.03, 95% CI = 1.01-1.05). Other variables associated with dose escalation were as follows: receiving medications from a nurse practitioner primary care provider (HR = 2.10, 95% CI = 1.12-3.96) or specialty physician (HR = 3.18, 95% CI = 1.22-8.34), relative to a physician primary care provider, and having undergone surgery within the past 6 months (HR = 1.80, 95% CI = 1.10-2.94). Other variables, including pain intensity, pain disability, or depression, were not associated with dose escalation.
In this 2-year prospective cohort study, variables associated with opioid dose escalation were lower opioid dose, higher pain catastrophizing, receiving opioids from a medical specialist (rather than primary care clinician) or nurse practitioner, and having recently undergone surgery. Study findings highlight intervention points that may be helpful for reducing the likelihood of future prescription opioid dose escalation.
先前的研究已确定了与处方阿片类药物起始使用相关的因素，但对于已经接受长期阿片类药物治疗（LTOT）的患者中剂量增加的患病率或预测因素知之甚少。
这是一项为期2年的前瞻性队列研究，旨在检查与阿片类药物剂量增加相关的患者和临床医生因素。
前瞻性队列研究。参与者在基线时以及每6个月接受一次检查，共持续2年。
从两个综合医疗系统（分别为凯撒医疗集团和退伍军人事务部）招募了因肌肉骨骼疼痛而接受稳定剂量LTOT治疗的患者。
处方阿片类药物剂量基于药房记录和自我报告。收集了关于阿片类药物处方临床医生的特征和医疗保健利用情况的管理数据。参与者完成了疼痛、功能和生活质量的测量。
在登记的参与者（n = 517）中，19.5%的患者阿片类药物剂量增加。在多变量分析中，与剂量增加相关的患者变量包括较低的阿片类药物剂量（风险比[HR] = 0.86，95%置信区间[CI] = 0.79 - 0.94，基线剂量每增加10毫克）和更高的疼痛灾难化程度（HR = 1.03，95% CI = 1.01 - 1.05）。与剂量增加相关的其他变量如下：相对于初级保健医生，从执业护士初级保健提供者（HR = 2.10，95% CI = 1.12 - 3.96）或专科医生（HR = 3.18，95% CI = 1.22 - 8.34）处接受药物治疗，以及在过去6个月内接受过手术（HR = 1.
