From the Department of Radiology, School of Medicine, University of Washington, Seattle, WA (LSG, KTJ, SKJ, JGJ); Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA (LSG, ENM, JAT, KTJ, JLF, PS, SKJ, PJH, JGJ); Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA (ZAM); Department of Biostatistics, University of Washington, Seattle, WA (ENM, PJH); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA (JAT); Department of Rehabilitation Medicine, University of Washington, Seattle, WA (JAT, JLF); Department of Radiology Mayo Clinic, Rochester, MN (DFK, PHL); Department of Radiology, Henry Ford Hospital, Detroit, MI, (BG); Kaiser Permanente Washington, Seattle, WA (KJS); Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA (PS); Departments of Family Medicine and Internal Medicine, Oregon Health & Science University, Portland, OR (RAD); Division of Research, Kaiser Permanente Northern California, Oakland, CA (ALA).
J Am Board Fam Med. 2021 Sep-Oct;34(5):950-963. doi: 10.3122/jabfm.2021.05.210033.
To describe characteristics of patients, providers, and clinics associated with opioid or non-opioid pain medication prescribing patterns for patients who received lower spine imaging in primary care clinics.
In these secondary analyses of the Lumbar Imaging with Reporting of Epidemiology (LIRE) study, a randomized controlled trial conducted in 4 health systems in the United States, we evaluated characteristics associated with receipt of pain medication prescriptions. The outcomes were receipt of prescriptions for opioid or, separately, non-opioid pain medications within 90 days after imaging. Among patients who received opioid or non-opioid prescriptions, we evaluated receipt of multiple prescriptions in the year following imaging. Mixed models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
Compared with whites, patients identified as Asian (OR, 0.53; 95% CI, 0.51-0.56), Native Hawaiian/Pacific Islander (OR, 0.73; 95% CI, 0.64-0.83), multiracial (OR, 0.84; 95% CI, 0.71-0.98) or Black (OR, 0.92; 95% CI, 0.89-0.96) had significantly reduced odds for receiving prescriptions for opioids within 90 days. Patients identified as Native American/Alaska Native had greater odds for receiving prescriptions for non-opioid pain medications within 90 days (OR, 1.12; 95% CI, 1.01-1.24). Receipt of pain prescriptions 120 days before imaging was strongly predictive of subsequent receipt of pain prescriptions across all categories.
After adjusting for factors that could affect prescribing, the strongest differences observed in pain-medication prescribing were across racial categories and for patients with previous pain prescriptions. Further research is needed to understand these differences and to optimize prescribing.
描述在初级保健诊所接受下脊柱影像学检查的患者、医疗服务提供者和诊所的特征，这些特征与接受阿片类或非阿片类疼痛药物处方模式有关。
在这项在美国 4 个医疗系统开展的、随机对照试验 Lumbar Imaging with Reporting of Epidemiology（LIRE）的二次分析中，我们评估了与接受疼痛药物处方相关的特征。结局是在影像学检查后 90 天内接受阿片类或非阿片类疼痛药物处方的情况。在接受阿片类或非阿片类药物处方的患者中，我们评估了在影像学检查后 1 年内接受多份处方的情况。采用混合模型估计调整后的优势比（OR）和 95%置信区间（CI）。
与白人相比，亚洲人（OR，0.53；95%CI，0.51-0.56）、夏威夷原住民/太平洋岛民（OR，0.73；95%CI，0.64-0.83）、多种族裔（OR，0.84；95%CI，0.71-0.98）或黑人（OR，0.92；95%CI，0.89-0.96）接受阿片类药物处方的可能性显著降低。被确定为美国原住民/阿拉斯加原住民的患者在 90 天内接受非阿片类疼痛药物处方的可能性更高（OR，1.12；95%CI，1.01-1.24）。影像学检查前 120 天接受疼痛处方与所有类别的后续疼痛处方的接受情况具有很强的预测性。
在调整了可能影响处方的因素后，在疼痛药物处方方面观察到的最大差异是在种族类别之间，以及在有先前疼痛处方的患者中。需要进一步研究以了解这些差异并优化处方。
