2012 - 2018年长期阿片类药物使用者尿液药物检测趋势
Trends in Urine Drug Testing Among Long-term Opioid Users, 2012-2018.
作者信息
Taha Shaden A, Westra Jordan R, Raji Mukaila A, Kuo Yong F
机构信息
Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas; Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas.
Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas; Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas.
出版信息
Am J Prev Med. 2021 Apr;60(4):546-551. doi: 10.1016/j.amepre.2020.10.011. Epub 2020 Dec 5.
INTRODUCTION
Long-term opioid therapy increases the risk of opioid overdose death. Government agencies and medical societies, including the Center for Disease Control and Prevention and the American Society for Clinical Oncology, emphasized risk mitigation strategies, including urine drug testing, in published guidelines. Urine drug testing rates, time trends, and covariates among long-term opioid therapy users were examined to gauge guideline adherence.
METHODS
Using Optum's De-identified Clinformatics DataMart, an incidence cohort (n=28,790) and prevalence cohort (n=621,449) were created to measure baseline and annual urine drug testing, respectively, from 2012 to 2018. Urine drug testing time trends were evaluated by demographics, pain conditions, and Elixhauser comorbidity index. A multivariable generalized estimating model was developed in 2020 to examine the factors associated with urine drug testing.
RESULTS
Annual urine drug testing rates doubled from 25.6% in 2012 to 52.2% in 2018, whereas baseline urine drug testing also increased from 3.75% to 11.1%. Annual urine drug testing increased within each age group over time; however, older patients (OR=0.21, 95% CI=0.21, 0.22, aged >79 years) and patients with cancer (OR=0.82, 95% CI=0.80, 0.84) were less likely to receive urine drug testing. Patients residing in the South (OR=1.99, 95% CI=1.96, 2.01) and those with back pain (OR=2.04, 95% CI=2.02, 2.06) or with other chronic pain (OR=1.64, 95% CI=1.62, 1.66) were significantly more likely to be tested. Independent predictors of baseline urine drug testing were similar to predictors of annual urine drug testing.
CONCLUSIONS
Despite increasing urine drug testing trends from 2012 to 2018, annual and baseline urine drug testing remained low in 2018, relative to numerous guideline recommendations. Findings suggest a need for research on better guideline implementation strategies and the effectiveness of urine drug testing on patient outcomes.
引言
长期使用阿片类药物治疗会增加阿片类药物过量致死的风险。包括疾病控制与预防中心和美国临床肿瘤学会在内的政府机构和医学协会在已发布的指南中强调了降低风险的策略，包括尿液药物检测。对长期使用阿片类药物治疗的患者的尿液药物检测率、时间趋势和协变量进行了研究，以评估对指南的遵循情况。
方法
利用Optum的去识别化临床信息数据集市，分别创建了一个发病率队列（n = 28,790）和一个患病率队列（n = 621,449），以测量2012年至2018年的基线尿液药物检测和年度尿液药物检测情况。通过人口统计学、疼痛状况和埃利克斯豪泽合并症指数评估尿液药物检测的时间趋势。2020年开发了一个多变量广义估计模型，以研究与尿液药物检测相关的因素。
结果
年度尿液药物检测率从2012年的25.6%翻倍至2018年的52.2%，而基线尿液药物检测也从3.75%增至11.1%。随着时间推移，每个年龄组的年度尿液药物检测率均有所上升；然而，老年患者（年龄>79岁，OR = 0.21，95%CI = 0.21, 0.22）和癌症患者（OR = 0.82，95%CI = 0.80, 0.84）接受尿液药物检测的可能性较小。居住在南方的患者（OR = 1.99，95%CI = 1.96, 2.01）以及患有背痛（OR = 2.04，95%CI = 2.02, 2.06）或其他慢性疼痛（OR = 1.64，95%CI = 1.62, 1.66）的患者接受检测的可能性显著更高。基线尿液药物检测的独立预测因素与年度尿液药物检测的预测因素相似。
结论
尽管2012年至2018年尿液药物检测趋势有所上升，但相对于众多指南建议，2018年的年度和基线尿液药物检测率仍然较低。研究结果表明需要对更好的指南实施策略以及尿液药物检测对患者预后的有效性进行研究。
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