初级保健提供者类型对退伍军人慢性疼痛管理的影响。

Influence of Primary Care Provider Type on Chronic Pain Management Among Veterans.

作者信息

Nikpour Jacqueline, Broome Marion, Silva Susan, Allen Kelli D

机构信息

University of Pennsylvania School of Nursing, Philadelphia.

Ruby F. Wilson Distinguished Professor of Nursing, Duke University School of Nursing, Durham, North Carolina.

出版信息

J Nurs Regul. 2022 Apr;13(1):35-44. doi: 10.1016/s2155-8256(22)00032-1. Epub 2022 Apr 17.

DOI:10.1016/s2155-8256(22)00032-1

PMID:35694638

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9182699/

Abstract

BACKGROUND

Chronic pain disproportionately impacts veterans and is often treated in primary care, where physician shortages in the Veterans Health Administration (VHA) healthcare system are well documented. Nurse practitioners (NPs) may represent a solution to the care shortage; however, concerns of NP opioid overprescribing have led to NP practice and prescribing restrictions in individual VHA facilities and at the state level. Little is known regarding the prescribing patterns of NPs and physician assistants (PAs) for veterans with chronic pain in the VHA.

PURPOSE

The purpose of this study was to compare opioid and non-opioid prescribing patterns of physicians, NPs, and PAs for chronic pain patients at VHA centers.

METHODS

We used data from the U.S. Department of Veterans Affairs Survey of Healthcare Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Patient medical records for the year were analyzed by provider type (physician, NP, or PA) for differences in providers' rates of prescribing opioid and non-opioid medications, as well as characteristics of the opioid prescriptions (e.g., high daily morphine milligram equivalent [90 MME/day] dose, long-term opioid therapy [90 days]).

RESULTS

Medical records of a total of 39,936 patients were included. In FY 2016, 55% of patients received one opioid prescription, whereas 83.8% received one non-opioid prescription. Compared to patients of NPs and PAs, patients of physicians had higher odds of receiving opioid (vs. NPs: OR = 1.13, < 0.01; vs. PAs: OR = 1.16, < 0.01) and non-opioid prescriptions (vs. NPs: OR=1.08, = 0.02; vs. PAs: OR=1.20, < 0.01) after adjusting for patient characteristics. There were no differences in high MME/day dose ( = 0.59) or long-term opioid therapy ( = 0.99).

CONCLUSION

In a national sample of veterans with chronic pain, NPs and PAs did not have higher odds of opioid prescribing. Concerns of NP or PA opioid overprescribing may be addressed by considering evidence that patients of these providers are not at higher odds of receiving an opioid prescription.

摘要

背景

慢性疼痛对退伍军人的影响尤为严重，且常在初级保健中进行治疗，而退伍军人健康管理局（VHA）医疗系统中医生短缺的情况有充分记录。执业护士（NP）可能是解决护理短缺问题的一个办法；然而，对NP过度开具阿片类药物的担忧导致了在个别VHA机构以及州一级对NP的执业和处方进行限制。关于VHA中NP和医师助理（PA）为慢性疼痛退伍军人开处方的模式，人们了解甚少。

目的

本研究的目的是比较VHA中心的医生、NP和PA为慢性疼痛患者开具阿片类药物和非阿片类药物的处方模式。

方法

我们使用了来自美国退伍军人事务部患者医疗体验调查和2015年10月至2016年9月的企业数据仓库的数据。按提供者类型（医生、NP或PA）分析当年患者的病历，以了解提供者开具阿片类药物和非阿片类药物的比率差异，以及阿片类药物处方的特征（例如，每日高吗啡毫克当量[90 MME/天]剂量、长期阿片类药物治疗[90天]）。

结果

共纳入39936名患者的病历。在2016财年，55%的患者接受了一张阿片类药物处方，而83.8%的患者接受了一张非阿片类药物处方。在对患者特征进行调整后，与NP和PA的患者相比，医生的患者接受阿片类药物（与NP相比：OR = 1.13，P < 0.01；与PA相比：OR = 1.16，P < 0.01）和非阿片类药物处方（与NP相比：OR = 1.08，P = 0.02；与PA相比：OR = 1.20，P < 0.01）的几率更高。每日高MME/天剂量（P = 0.59）或长期阿片类药物治疗（P = 0.99）方面没有差异。