Pakieser Jennifer, Peters Sidney, Tilley Laura C, Costantino Ryan C, Scott-Richardson Maya, Highland Krista B
School of Medicine, Uniformed Services University, Bethesda, MD, USA.
Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD, USA.
Pain Rep. 2021 Mar 14;7(2):e993. doi: 10.1097/PR9.0000000000000993. eCollection 2022 Mar-Apr.
Despite public health campaigns, policies, and educational programs, naloxone prescription rates among people receiving opioids remains low. In June 2018, the U.S. Military Health System (MHS) released 2 policies to improve naloxone prescribing.
The objective of this study was to examine whether the policies resulted in increased naloxone coprescription rates for patients who met the criteria for 1 or more risk indicators (eg, long-term opioid therapy, benzodiazepine coprescription, morphine equivalent daily dose ≥50 mg, and elevated overdose risk score) at the time of opioid dispense.
Prescription and risk indicator data from January 2017 to February 2021 were extracted from the MHS Data Repository. Naloxone coprescription rates from January 2017 to September 2018 were used to forecast prescribing rates from October 2018 to February 2021 overall and across risk indicators. Forecasted rates were compared with actual rates using Bayesian time series analyses.
The probability of receiving a naloxone coprescription was higher for patients whose opioid prescriber and pharmacy were both within military treatment facilities vs both within the purchased-care network. Bayesian time series results indicated that the number of patients who met the criteria for any risk indicator decreased throughout the study period. Naloxone prescribing rates increased across the study period from <1% to 20% and did not significantly differ from the forecasted rates across any and each risk indicator (adjusted values all >0.05).
Future analyses are needed to better understand naloxone prescribing practices and the impact of improvements to electronic health records, decision support tools, and policies.
尽管开展了公共卫生运动、制定了相关政策并实施了教育项目，但接受阿片类药物治疗的人群中纳洛酮处方率仍然很低。2018年6月，美国军事卫生系统（MHS）发布了两项政策以改善纳洛酮的处方开具情况。
本研究的目的是检验这些政策是否导致在阿片类药物配药时符合一项或多项风险指标标准（例如，长期阿片类药物治疗、同时开具苯二氮䓬类药物、每日吗啡当量≥50毫克以及过量用药风险评分升高）的患者的纳洛酮联合处方率有所提高。
从MHS数据存储库中提取了2017年1月至2021年2月的处方和风险指标数据。使用2017年1月至2018年9月的纳洛酮联合处方率来预测2018年10月至2021年2月总体以及各风险指标的处方率。使用贝叶斯时间序列分析将预测率与实际率进行比较。
阿片类药物开方者和药房均在军事治疗机构内的患者接受纳洛酮联合处方的可能性高于两者均在购买护理网络内的患者。贝叶斯时间序列结果表明，在整个研究期间，符合任何风险指标标准的患者数量有所减少。在整个研究期间，纳洛酮处方率从<1%提高到了20%，并且在任何和每个风险指标方面与预测率均无显著差异（调整后的值均>0.05）。
需要进行进一步分析，以更好地了解纳洛酮处方开具做法以及电子健康记录、决策支持工具和政策改进的影响。
