Wellspan York Hospital, Department of Emergency Medicine, 1001 South George Street, York, PA, 17403, USA.
University of Maryland Global Campus, 1616 McCormick Dr, Largo, MD 20774, USA.
Am J Emerg Med. 2022 Jun;56:63-70. doi: 10.1016/j.ajem.2022.03.040. Epub 2022 Mar 26.
The COVID-19 pandemic was superimposed upon an ongoing epidemic of opioid use disorder and overdose deaths. Although the trend of opioid prescription patterns (OPP) had decreased in response to public health efforts before the pandemic, little is known about the OPP from emergency department (ED) clinicians during the COVID-19 pandemic.
We conducted a pre-post study of adult patients who were discharged from 13 EDs and one urgent care within our academic medical system between 01/01/2019 and 09/30/2020 using an interrupted time series (ITS) approach. Patient characteristics and prescription data were extracted from the single unified electronic medical record across all study sites. Prescriptions of opioids were converted into morphine equivalent dose (MED). We compared the "Covid-19 Pandemic" period (C19, 03/29/2020-9/30/2020) and the "Pre-Pandemic" period (PP, 1/19/2020-03/28/2020). We used a multivariate logistic regression to assess clinical factors associated with opioid prescriptions.
We analyzed 361,794 ED visits by adult patients, including 259,242 (72%) PP and 102,552 (28%) C19 visits. Demographic information and percentages of patients receiving opioid prescriptions were similar in both groups. The median [IQR] MED per prescription was higher for C19 patients (70 [56-90]) than for PP patients (60 [60-90], P < 0.001). ITS demonstrated a significant trend toward higher MED prescription per ED visit during the pandemic (coefficient 0.11, 95% CI 0.05-0.16, P = 0.002). A few factors, that were associated with lower likelihood of opioid prescriptions before the pandemic, became non-significant during the pandemic.
Our study demonstrated that emergency clinicians increased the prescribed amount of opioids per prescription during the COVID-19 pandemic compared to the pre-pandemic period. Etiologies for this finding could include lack of access to primary care and other specialties during the pandemic, or lower volumes allowing for emergency clinicians to identify who is safe to be prescribed opioids.
COVID-19 大流行叠加了阿片类药物使用障碍和过量死亡的持续流行。尽管在大流行之前，公共卫生措施已经减少了阿片类药物处方模式（OPP）的趋势，但我们对大流行期间急诊科（ED）临床医生的 OPP 知之甚少。
我们使用中断时间序列（ITS）方法，对在我们的学术医疗系统中的 13 家急诊科和一家急症护理中心从 2019 年 1 月 1 日至 2020 年 9 月 30 日出院的成年患者进行了一项前后研究。从所有研究地点的单一统一电子病历中提取患者特征和处方数据。将阿片类药物处方转换为吗啡当量剂量（MED）。我们比较了“COVID-19 大流行”期间（C19，2020 年 3 月 29 日至 9 月 30 日）和“大流行前”期间（PP，2020 年 1 月 19 日至 2020 年 3 月 28 日）。我们使用多变量逻辑回归来评估与阿片类药物处方相关的临床因素。
我们分析了 361794 名成年患者的 ED 就诊情况，其中 259242 名（72%）为 PP，102552 名（28%）为 C19 就诊。两组患者的人口统计学信息和接受阿片类药物处方的患者百分比相似。C19 患者的 MED 处方中位数[IQR]（70[56-90]）高于 PP 患者（60[60-90]，P <0.001）。ITS 显示，大流行期间 ED 就诊时 MED 处方量呈显著上升趋势（系数 0.11，95%CI 0.05-0.16，P = 0.002）。一些在大流行前与阿片类药物处方可能性较低相关的因素在大流行期间变得不显著。
我们的研究表明，与大流行前相比，急诊科临床医生在 COVID-19 大流行期间增加了每例处方的阿片类药物用量。这种发现的原因可能包括大流行期间无法获得初级保健和其他专科治疗，或者就诊人数较少，使急诊科临床医生能够确定哪些人可以安全开具阿片类药物处方。
