接受协调门诊医疗保健的肌肉骨骼疾病患者与接受常规护理的患者之间阿片类药物处方率的差异：一项回顾性观察队列研究。

Differences in opioid prescription rates between patients with musculoskeletal disorders enrolled in coordinated ambulatory healthcare and patients receiving usual care: a retrospective observational cohort study.

机构信息

Institute of General Practice, Goethe University, Frankfurt am Main, Germany

Institute of General Practice, Goethe University, Frankfurt am Main, Germany.

出版信息

BMJ Open. 2022 Aug 8;12(8):e062657. doi: 10.1136/bmjopen-2022-062657.

DOI:10.1136/bmjopen-2022-062657

PMID:35940832

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9364404/

Abstract

OBJECTIVES

To compare opioid prescription rates between patients enrolled in coordinated ambulatory care and patients receiving usual care.

DESIGN

In this retrospective cohort study, we analysed claims data for insured patients with non-specific/specific back pain or osteoarthritis of hip or knee from 2014 to 2017.

SETTING

The study was based on administrative data provided by the statutory health insurance fund 'Allgemeine Ortskrankenkasse', in the state of Baden-Wurttemberg, Germany.

PARTICIPANTS

The intervention group consisted of patients enrolled in a coordinated ambulatory healthcare model; the control group included patients receiving usual care. Outcomes were overall strong and weak opioid prescriptions. Generalised linear regression models were used to analyse the effect of the intervention.

RESULTS

Overall, 46 001 (non-specific 18 787/specific 27 214) patients with back pain and 19 366 patients with osteoarthritis belonged to the intervention group, and 7038 (2803/4235) and 963 patients to the control group, respectively. No significant difference in opioid prescriptions existed between the groups. However, the chance of being prescribed strong opioids was significantly lower in the intervention group (non-specific back pain: Odds Ratio (OR) 0.735, 95% Confidential Interval (CI) 0.563 to 0.960; specific back pain: OR 0.702, 95% CI 0.577 to 0.852; osteoarthritis: OR 0.644, 95% CI 0.464 to 0.892). The chance of being prescribed weak opioids was significantly higher in patients with specific back pain (OR 1.243, 95% CI 1.032 to 1.497) and osteoarthritis (OR 1.493, 95% CI 1.037 to 2.149) in the intervention group.

CONCLUSION

Coordinated ambulatory healthcare appears to be associated with a lower prescription rate for strong opioids in patients with chronic musculoskeletal disorders.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register (DRKS00017548).

摘要

目的

比较纳入协调门诊护理的患者和接受常规护理的患者之间的阿片类药物处方率。

设计

在这项回顾性队列研究中，我们分析了 2014 年至 2017 年期间来自有非特异性/特异性背痛或髋或膝关节骨关节炎的参保患者的索赔数据。

设置

该研究基于德国巴登-符腾堡州法定健康保险基金“Allgemeine Ortskrankenkasse”提供的行政数据。

参与者

干预组包括参加协调门诊医疗保健模式的患者；对照组包括接受常规护理的患者。结果是总体上强阿片类药物和弱阿片类药物的处方。使用广义线性回归模型分析干预的效果。

结果

总体而言，46001 名（非特异性 18787/特异性 27214）有背痛的患者和 19366 名患有骨关节炎的患者属于干预组，7038 名（2803/4235）和 963 名属于对照组。两组之间的阿片类药物处方没有显著差异。然而，在干预组中，强阿片类药物的处方几率明显较低（非特异性背痛：优势比（OR）0.735，95%置信区间（CI）0.563 至 0.960；特异性背痛：OR 0.702，95%CI 0.577 至 0.852；骨关节炎：OR 0.644，95%CI 0.464 至 0.892）。在干预组中，特异性背痛（OR 1.243，95%CI 1.032 至 1.497）和骨关节炎（OR 1.493，95%CI 1.037 至 2.149）患者服用弱阿片类药物的几率明显更高。