Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan.
Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy & Innovation, University of Michigan Medical School, Ann Arbor, Michigan; Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
Am J Prev Med. 2022 Mar;62(3):317-325. doi: 10.1016/j.amepre.2021.09.017.
It is unknown whether certain dentists account for disproportionate shares of dental opioid prescriptions and high-risk prescriptions. Identifying and characterizing such dentists could inform the targeting of initiatives to improve the appropriateness and safety of dental opioid prescribing.
In May 2021, the authors conducted a cross-sectional analysis using the IQVIA Longitudinal Prescription Database, which reports dispensing from 92% of U.S. pharmacies, and 2 provider databases (IQVIA OneKey, National Plan and Provider Enumeration System). Analyses included opioid prescriptions from dentists dispensed in 2019 to patients aged >12 years. High-risk prescriptions were those considered high risk by any of 3 metrics (prescriptions to opioid-naïve patients exceeding a 3-day supply, prescriptions with daily opioid dosage ≥50 morphine milligram equivalents, opioid prescriptions with benzodiazepine overlap). Among all prescriptions and high-risk prescriptions, the authors calculated the proportion accounted for by high-volume dentists -- those with prescription counts in the 95th percentile or higher. Using logistic regression, the characteristics associated with being a high-volume dentist were identified.
In 2019, a total of 141,345 dentists accounted for 10,736,743 opioid prescriptions dispensed to patients aged >12 years; 4,242,634 (39.5%) were high-risk prescriptions. The 7,079 high-volume dentists, a group representing 5.0% of the 141,345 dentists, accounted for 46.9% of all prescriptions and 47.5% of high-risk prescriptions. Male sex, younger age, non‒Northeast location, and specialization in oral and maxillofacial surgery were associated with a higher risk of being a high-volume dentist.
In 2019, high-volume dentists accounted for almost half of dental opioid prescriptions and high-risk prescriptions. Quality improvement initiatives targeting these dentists may be warranted.
目前尚不清楚是否有某些牙医开出的阿片类药物处方和高风险处方比例过高。确定并描述这类牙医的特征，可以为有针对性地开展提高牙科阿片类药物处方适当性和安全性的计划提供信息。
2021 年 5 月，作者使用 IQVIA 纵向处方数据库（该数据库报告了美国 92%的药店和 2 个供应商数据库（IQVIA OneKey、国家计划和供应商枚举系统）的配药情况）进行了一项横断面分析。分析包括 2019 年向年龄大于 12 岁的患者开出的牙医阿片类药物处方。高风险处方是指根据 3 种指标中的任何一种被认为高风险的处方（给阿片类药物初治患者开出的处方超过 3 天的供应量，每日阿片类药物剂量≥50 毫克等效物，阿片类药物处方与苯二氮䓬类药物重叠）。在所有处方和高风险处方中，作者计算了高处方量牙医（处方量处于第 95 百分位数或更高的牙医）所占的比例。使用逻辑回归确定了与成为高处方量牙医相关的特征。
2019 年，共有 141345 名牙医向年龄大于 12 岁的患者开出了 10736743 张阿片类药物处方；其中 4242634 张（39.5%）为高风险处方。7079 名高处方量牙医（占 141345 名牙医的 5.0%）开出的处方占所有处方的 46.9%，占高风险处方的 47.5%。男性、年龄较小、非东北地区和口腔颌面外科专业与成为高处方量牙医的风险增加相关。
2019 年，高处方量牙医开出的阿片类药物处方和高风险处方几乎占一半。针对这些牙医开展质量改进计划可能是必要的。
