Muench John, Hoopes Megan, Mayhew Meghan, Pisciotta Maura, Shortreed Susan M, Livingston Catherine J, Von Korff Michael, DeBar Lynn L
From the Oregon Health & Science University, Portland, OR (JM); OCHIN, Inc., Portland, OR (MH and MP); Kaiser Permanente Center for Health Research, Portland, OR (MM, SMS, MVK, and LLD); and Oregon Health & Science University, Portland, OR (CJL).
J Am Board Fam Med. 2022 Mar-Apr;35(2):352-369. doi: 10.3122/jabfm.2022.02.210306.
Beginning around 2011, innumerable policies have aimed to improve pain treatment while minimizing harms from excessive use of opioids. It is not known whether changing insurance coverage for specific conditions is an effective strategy. We describe and assess the effect of an innovative Oregon Medicaid back/neck pain coverage policy on opioid prescribing patterns.
This retrospective cohort study uses electronic health record data from a network of community health centers (CHCs) in Oregon to analyze prescription opioid dose changes among patients on long-term opioid treatment (LOT) affected by the policy.
Of the 1,789 patients on LOT at baseline, 41.6% had an average daily dose of <20 morphine milligram equivalents (MME), 32.3% had ≥20 to <50 MME, 14.5% had ≥50 to <90 MME, and 11.6% ≥90 MME. Around half of each group discontinued opioids within the 18-month policy period. Those who discontinued did so gradually (average of 11 months) regardless of starting dosage. Predictors of discontinuation included: diagnosis of opioid use disorder, older, non-Hispanic white, and less medical complexity.
Regardless of starting opioid dose, nearly half of patients affected by the 2016 Oregon Medicaid back/neck pain treatment policy no longer received opioid prescriptions by the end of the 18-month study period; another 30% decreased their dose. Gradual dose reduction was typical. These outcomes suggest that the policy impacted opioid prescribing. Understanding patient experiences resulting from such policies could help clinicians and policy makers navigate the complex balance between potential harms and benefits of LOT.
从2011年左右开始，无数政策旨在改善疼痛治疗，同时将阿片类药物过度使用造成的危害降至最低。尚不清楚改变特定疾病的保险覆盖范围是否是一种有效的策略。我们描述并评估了俄勒冈医疗补助计划一项创新的背部/颈部疼痛覆盖政策对阿片类药物处方模式的影响。
这项回顾性队列研究使用了俄勒冈州社区卫生中心（CHC）网络的电子健康记录数据，以分析受该政策影响的长期阿片类药物治疗（LOT）患者的处方阿片类药物剂量变化。
在基线时接受LOT治疗的1789名患者中，41.6%的患者平均每日剂量<20毫克吗啡当量（MME），32.3%的患者≥20至<50 MME，14.5%的患者≥50至<90 MME，11.6%的患者≥90 MME。在18个月的政策期内，每组约有一半的患者停用了阿片类药物。停药的患者是逐渐停药的（平均11个月），与起始剂量无关。停药的预测因素包括：阿片类药物使用障碍的诊断、年龄较大、非西班牙裔白人以及医疗复杂性较低。
无论起始阿片类药物剂量如何，到18个月研究期结束时，受2016年俄勒冈医疗补助计划背部/颈部疼痛治疗政策影响的患者中，近一半不再接受阿片类药物处方；另有30%减少了剂量。逐渐减少剂量是常见的。这些结果表明该政策对阿片类药物处方产生了影响。了解此类政策导致的患者经历有助于临床医生和政策制定者在长期阿片类药物治疗的潜在危害和益处之间把握复杂的平衡。
