Department of Obstetrics and Gynecology, Naval Hospital Camp Pendleton, 200 Mercy Circle, Oceanside, California.
Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland.
Am J Perinatol. 2024 Jan;41(1):60-66. doi: 10.1055/s-0041-1740006. Epub 2021 Nov 16.
OBJECTIVE: The aim of the study is to evaluate the prevalence and factors associated with opioid prescriptions to postpartum patients among TRICARE beneficiaries receiving care in the civilian health care system versus a military health care facility. STUDY DESIGN: We evaluated postpartum opioid prescriptions filled at discharge among patients insured by TRICARE Prime/Prime Plus using the Military Health System Data Repository between fiscal years 2010 to 2015. We included women aged 15 to 49 years old and excluded abortive pregnancy outcomes and incomplete datasets. The primary outcome investigated mode of delivery and demographics for those filling an opioid prescription. Secondary outcomes compared prevalence of filled opioid prescription at discharge for postpartum patients within civilian care and military care. RESULTS: Of a total of 508,258 postpartum beneficiaries, those in civilian health care were more likely to fill a discharge opioid prescription compared with those in military health care (OR 3.9, 95% CI 3.8-3.99). Cesarean deliveries occurred less frequently in military care (26%) compared with civilian care (30%), and forceps deliveries occurred more frequently in military care (1.38%) compared with civilian care (0.75%). Women identified as Asian race were least likely to fill an opioid prescription postpartum (OR 0.79, 95% CI 0.75-0.83). Women aged 15 to 19 years had a lower odds of filling an opioid prescription (OR 0.83, 95% CI 0.80-0.86). Women associated with a senior officer rank were less likely to fill an opioid prescription postpartum (OR 0.83, 95% CI 0.73-0.91), while those associated with warrant officer rank were more likely to fill an opioid prescription (OR 1.14, 95% CI 1.06-1.23). CONCLUSION: Our data indicates that women who received care in civilian facilities were more likely to fill an opioid prescription at discharge when compared with military facilities. Factors such as race and age were associated with opioid prescription at discharge. This study highlights areas for improvement for potential further studies. KEY POINTS: · Opioid prescription patterns for postpartum women may vary across the country.. · Our study indicates postpartum patients in civilian care are more likely to fill opioids postpartum.. · This study highlights a population which may have an improved opioid prescribing pattern..
目的：本研究旨在评估在接受民用医疗保健系统和军事医疗保健机构护理的 TRICARE 受益人群中，产后患者开具阿片类药物处方的流行率和相关因素。
研究设计：我们使用军事医疗系统数据资源库，评估了 2010 年至 2015 年期间，接受 TRICARE Prime/Prime Plus 保险的产后患者出院时阿片类药物处方的使用情况。我们纳入了年龄在 15 至 49 岁之间的女性，并排除了流产结局和不完整的数据集。主要结局是调查那些开阿片类药物处方的患者的分娩方式和人口统计学特征。次要结局比较了民用保健和军事保健产后患者出院时阿片类药物处方的开具率。
结果：在总共 508258 名产后受益人群中，与在军事保健机构相比，在民用保健机构的患者更有可能开具出院阿片类药物处方（OR 3.9，95%CI 3.8-3.99）。与民用保健相比，军事保健中剖宫产的发生率较低（26%），产钳的使用率较高（1.38%），而民用保健中则为 0.75%。亚裔女性产后开具阿片类药物处方的可能性最低（OR 0.79，95%CI 0.75-0.83）。15 至 19 岁的女性开具阿片类药物处方的可能性较低（OR 0.83，95%CI 0.80-0.86）。与高级军官级别相关的女性产后开具阿片类药物处方的可能性较低（OR 0.83，95%CI 0.73-0.91），而与准尉级别相关的女性开具阿片类药物处方的可能性较高（OR 1.14，95%CI 1.06-1.23）。
结论：我们的数据表明，与军事医疗机构相比，在民用医疗机构接受治疗的女性在出院时更有可能开具阿片类药物处方。种族和年龄等因素与出院时的阿片类药物处方有关。本研究强调了潜在进一步研究的改进领域。
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