急诊临床医生开具阿片类药物处方组与 1 年患者结局的关联：一项有陆军现役士兵参与的队列研究。
Association between 1-year patient outcomes and opioid-prescribing group of emergency department clinicians: A cohort study with Army active-duty soldiers.
机构信息
Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
出版信息
Acad Emerg Med. 2021 Nov;28(11):1251-1261. doi: 10.1111/acem.14331. Epub 2021 Aug 25.
OBJECTIVE
The objective was to examine the association between clinicians' opioid prescribing group and patients' outcomes among patients treated in the emergency department (ED).
METHODS
This was a retrospective cohort study. The setting was the EDs of the U.S. Military Health System (MHS). Patients were 181,557 Army active-duty opioid-naïve (no fill in past 180 days) patients with an index encounter to the ED between October 2010 and September 2016. Exposure was patients classified by opioid prescribing tier of the treating ED clinician: top, middle, or bottom third relative to the clinician's peers in the same ED. Follow-up measurement was from 31 to 365 days after the index encounter. The primary outcome was long-term opioid prescriptions (LTOPs) defined as 180 (or more) days' supply within the follow-up window. We also computed the total morphine milligram equivalents (MME) and total opioid days' supply. Secondary measures were any repeat ED encounter, any hospitalization, any sick leave, and any military-duty restriction.
RESULTS
We found a 2.5-fold variation in opioid prescribing rates among clinicians in the same MHS ED. Controlling for sample demographics, reason for encounter, and military background, in multivariate analyses the odds of receiving a 180-day opioid supply during follow-up were 1.19 (95% confidence interval [CI] = 1.01 to 1.40, p < 0.05) for the top opioid exposure group and 1.37 (95% CI = 1.19 to 1.57, p < 0.001) for the middle opioid exposure group compared to the bottom exposure group, and there were significant increases in total opioid days' supply and total MME. There were no differences in secondary outcome measures.
CONCLUSION
In a relatively healthy sample of Army soldiers, variation in opioid exposure defined by clinician's prescribing history was associated with increased odds of LTOP and increase in opioid volume, but not in functional outcomes.
目的
本研究旨在探讨急诊科（ED）医生开具阿片类药物的类别与患者结局之间的关系。
方法
这是一项回顾性队列研究。研究地点为美国军事医疗系统（MHS）的 ED。研究对象为 2010 年 10 月至 2016 年 9 月期间因指数就诊至 ED 的 181557 例阿片类药物-naive（过去 180 天内无用药记录）的现役军人。暴露因素为根据 ED 医生开具阿片类药物的类别将患者分为高、中、低三个层级，即医生在同一 ED 中的同行中处于前 1/3、中 1/3 和后 1/3。随访时间为指数就诊后 31 至 365 天。主要结局为长期阿片类药物处方（LTOP），定义为在随访期间开具 180 天（或以上）的阿片类药物。我们还计算了总吗啡毫克当量（MME）和总阿片类药物天数。次要指标为任何重复 ED 就诊、任何住院、任何病假和任何军事职责限制。
结果
我们发现，在同一 MHS ED 中，医生开具阿片类药物的比率存在 2.5 倍的差异。在校正样本人口统计学特征、就诊原因和军事背景后，多变量分析显示，在随访期间接受 180 天阿片类药物供应的可能性，与高阿片类药物暴露组（OR = 1.19，95%CI = 1.01-1.40，p < 0.05）和中阿片类药物暴露组（OR = 1.37，95%CI = 1.19-1.57，p < 0.001）相比，低阿片类药物暴露组分别增加 1.19 倍和 1.37 倍，且总阿片类药物天数和总 MME 显著增加。次要结局指标无差异。
结论
在一个相对健康的陆军士兵样本中，医生开具阿片类药物的历史所定义的阿片类药物暴露差异与 LTOP 发生几率的增加和阿片类药物用量的增加有关，但与功能结局无关。
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