Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky, USA.
Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA.
J Rural Health. 2022 Sep;38(4):900-907. doi: 10.1111/jrh.12653. Epub 2022 Feb 27.
In response to the COVID-19 pandemic, the US DEA allowed controlled substance prescriptions to be issued following a telemedicine encounter. This study evaluated changes in opioid prescribing in Kentucky counties with low and high rates of broadband subscription before, during, and after a series of statewide emergency declarations that may have affected health care access.
The study used the prescription drug monitoring program to analyze records of opioid analgesic prescriptions dispensed to opioid-naïve individuals in high (N = 26) and low (N = 94) broadband access counties during 3 periods: before a state of emergency (SOE) and executive order (EO) limiting nonemergent health care services (January 2019-February 2020), while the EO was active (March-April 2020), and after health care services began reopening (May-December 2020). Marginal generalized estimating equations-type negative binomial models were fit to compare prescription counts by broadband access over the 3 periods.
Rates of opioid dispensing to opioid-naïve individuals decreased significantly during the EO, but increased nearly to pre-SOE levels after health care services began reopening. Dispensing rates in low broadband counties were higher than those in high broadband counties during all time periods, although these differences were negligible after adjusting for potential confounders. During the EO, prescriptions were written for longer days' supply in both county types.
The overall dramatic reduction in opioid prescribing rates should be considered when evaluating annual opioid prescribing trends. However, broadband subscription rate did not appear to influence opioid prescriptions dispensed in Kentucky during the EO.
为应对 COVID-19 大流行，美国缉毒局允许在远程医疗就诊后开具受控物质处方。本研究评估了在一系列可能影响医疗保健可及性的全州紧急声明前后，宽带订阅率低和高的肯塔基县的阿片类药物处方情况的变化。
该研究使用处方药物监测计划，分析了在紧急状态（SOE）和限制非紧急医疗服务的行政命令（EO）之前（2019 年 1 月至 2 月）、EO 生效期间（2020 年 3 月至 4 月）和医疗服务重新开始后（2020 年 5 月至 12 月），高（N=26）和低（N=94）宽带接入县中阿片类药物镇痛剂处方分配给阿片类药物-naïve 个体的记录。使用边缘广义估计方程型负二项式模型，按宽带接入情况比较 3 个时期的处方数量。
EO 期间，向阿片类药物-naïve 个体的阿片类药物配药率显著下降，但在医疗服务重新开始后，几乎恢复到 SOE 前的水平。在所有时期，低宽带县的配药率均高于高宽带县，但在调整潜在混杂因素后，差异可以忽略不计。在 EO 期间，两种类型的县都开了更长天数的处方。
在评估年度阿片类药物处方趋势时，应考虑到阿片类药物处方总体大幅减少的情况。然而，在 EO 期间，宽带订阅率似乎并未影响肯塔基州的阿片类药物处方。
