Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.
J Gen Intern Med. 2022 Jun;37(8):1838-1844. doi: 10.1007/s11606-021-06966-4. Epub 2021 Jul 8.
Many states have implemented opioid days' supply restriction policies, leading to reductions in opioid prescribing. Although research within certain provider types exist, no study has evaluated a restriction policy by various provider types.
To evaluate changes in opioid utilization following a days' supply restriction policy stratified by provider type: surgery, emergency medicine, primary care, specialty care, and dentistry.
Interrupted time series (ITS) PARTICIPANTS: Opioid prescription claims of patients in a private health plan serving a large Florida employer from 1/1/2015 to 3/31/2019. Provider types were determined using the Healthcare Provider Taxonomy Code associated with the national provider identifier (NPI).
Florida's opioid restriction policy implemented on July 1, 2018.
Changes in mean morphine milligram equivalent (MMEs), mean days' supply, and mean number of units dispensed per opioid prescription before and after policy implementation.
There were 10,583 opioid initial prescriptions dispensed. Treating providers were classified as surgery (16.4%; n = 1732), emergency care (14.3%; n = 1516), primary care (21.2%; n = 2241), specialty care (11.4%; n = 1207), and dentistry providers (23.7%; n = 2511). Significant reductions in mean days' supply were observed across most provider types ranging from 14% reduction for dentistry providers to 41% reduction for specialty care providers. Significant changes were observed for emergency care and specialty care providers with a 30% (p = 0.001)and 29% (p < 0.001) reduction in mean MME, respectively, and a 27% (p = 0.040) reduction in mean number of units dispensed in emergency care providers, after implementation. Pre-implementation trends in opioid prescribing varied by provider type impacting the effects of the opioid days' supply restriction policy.
Pre-policy opioid prescribing varied by provider type with a differential impact on mean MMEs, mean days' supply, and mean number of units dispensed per prescription following implementation.
许多州都实施了阿片类药物供应天数限制政策，导致阿片类药物的处方量减少。尽管某些类型的提供者已经开展了相关研究，但尚无研究评估按提供者类型（外科、急诊医学、初级保健、专科保健和牙科）实施限制政策的效果。
评估按提供者类型（外科、急诊医学、初级保健、专科保健和牙科）分层的阿片类药物使用量在实施供应天数限制政策后的变化。
中断时间序列（ITS）
2015 年 1 月 1 日至 2019 年 3 月 31 日期间，在一家为佛罗里达州大型雇主提供服务的私人健康计划中就诊的患者的阿片类药物处方。使用与国家提供者标识符（NPI）相关联的医疗保健提供者分类代码确定提供者类型。
佛罗里达州的阿片类药物限制政策于 2018 年 7 月 1 日实施。
政策实施前后平均吗啡毫克当量（MME）、平均供应天数和每张阿片类药物处方平均配药单位数的变化。
共开出 10583 张初始阿片类药物处方。治疗提供者被分为外科（16.4%，n=1732）、急诊（14.3%，n=1516）、初级保健（21.2%，n=2241）、专科保健（11.4%，n=1207）和牙科（23.7%，n=2511）。大多数提供者类型的平均供应天数都有显著减少，从牙科提供者减少 14%到专科保健提供者减少 41%不等。急诊和专科保健提供者发生了显著变化，其平均 MME 分别减少了 30%（p=0.001）和 29%（p<0.001），急诊保健提供者平均配药单位数减少了 27%（p=0.040）。实施后，急诊保健提供者的阿片类药物处方开具量呈下降趋势。实施阿片类药物供应天数限制政策之前，各提供者类型的阿片类药物处方开具情况存在差异，这对政策的效果产生了影响。
在实施阿片类药物供应天数限制政策之前，各提供者类型的阿片类药物处方开具情况存在差异，实施后对平均 MME、平均供应天数和每张处方平均配药单位数的影响也存在差异。
