高危处方类阿片使用者的住院用药重整。

Hospital admission medication reconciliation in high-risk prescription opioid users.

机构信息

Department of Clinical Pharmacy, University of California San Francisco (UCSF), USA; Medication Outcomes Center, University of California San Francisco (UCSF), USA; Philip R. Lee Institute for Health Policy Studies at the University of California San Francisco (UCSF), USA.

Medication Outcomes Center, University of California San Francisco (UCSF), USA.

出版信息

Res Social Adm Pharm. 2022 Aug;18(8):3379-3385. doi: 10.1016/j.sapharm.2021.11.010. Epub 2021 Nov 23.

DOI:10.1016/j.sapharm.2021.11.010

PMID:34972641

Abstract

BACKGROUND

No studies have assessed the clinical significance of medication reconciliation in surgical patients using high-risk extended-release/long-acting (ER/LA) opioid medications.

OBJECTIVES

We assessed differences in the perioperative use of opioid analgesics in patients who underwent medication reconciliation upon hospital admission compared to patients who did not and identified predictors of perioperative use of opioids.

METHODS

Retrospective observational quasi-experimental study including adult non-cancer patients who underwent elective surgery at UCSF Medical Center in the period January 2017 through December 2019 and received at least one opioid analgesic during surgical hospitalization. The primary study outcome was perioperative use of opioids measured in daily oral morphine equivalents (OME). Secondary outcomes were predictors of perioperative use of opioids after adjusting for baseline differences between groups.

RESULTS

We identified 402 patients. Of them, 59.5% were female. The mean patient age was 58.5 years. Most patients underwent neurological or orthopedic surgery (each 40.8%). Over 94.3% of our patients underwent medication reconciliation upon hospital admission, with 78.4% completed by a pharmacy staff. Medication reconciliation evidenced that 5.5% patients were not taking the ER/LA opioids on their medication history list. Inactive ER/LA opioids were discontinued during hospitalization. None of the patients with inactive ER/LA opioids had those opioids restarted at hospital discharge. In addition, patients (26.9%) were successfully converted from ER/LA to SA opioids. After adjusting for patients' demographic and clinical characteristics, surgical procedure type and post-operative pain, opioid formulation conversion was the main predictor of perioperative use of opioids per hospitalization day. Switching patients from ER/LA to SA opioids reduced the mean daily use of OME by 66.03 units (p < 0.02) without adversely impacting postoperative pain.

CONCLUSIONS

Medication reconciliation upon hospital admission reduced unnecessary exposure to opioids in hospitalized surgical patients.

摘要

背景

目前尚无研究评估在使用高风险的延长释放/长效（ER/LA）阿片类药物的外科患者中，药物重整对临床的影响。

目的

我们评估了入院时进行药物重整的患者与未进行药物重整的患者在围手术期使用阿片类镇痛药的差异，并确定了围手术期使用阿片类药物的预测因素。

方法

这是一项回顾性观察性准实验研究，纳入 2017 年 1 月至 2019 年 12 月期间在旧金山加州大学医学中心接受择期手术的成年非癌症患者，这些患者在手术住院期间至少使用过一种阿片类镇痛药。主要研究结果是通过每日口服吗啡等效剂量（OME）来衡量围手术期使用阿片类药物的情况。次要结果是调整组间基线差异后，预测围手术期使用阿片类药物的因素。

结果

共纳入 402 例患者，其中 59.5%为女性，平均年龄为 58.5 岁。大多数患者接受神经外科或骨科手术（各占 40.8%）。超过 94.3%的患者在入院时进行了药物重整，其中 78.4%由药剂师完成。药物重整发现，5.5%的患者在他们的药物史列表中未服用 ER/LA 阿片类药物。住院期间停用了无活性的 ER/LA 阿片类药物。没有无活性的 ER/LA 阿片类药物的患者在出院时重新开始使用这些药物。此外，26.9%的患者成功地从 ER/LA 转换为 SA 阿片类药物。在调整了患者的人口统计学和临床特征、手术类型和术后疼痛后，阿片类药物剂型转换是每住院日使用阿片类药物的主要预测因素。将患者从 ER/LA 转换为 SA 阿片类药物可使平均每日 OME 使用量减少 66.03 单位（p<0.02），而不会对术后疼痛产生不利影响。