Dai Zhaoli, Raban Magdalena Z, Sezgin Gorkem, McGuire Precious, Datta Shirmilla, Wabe Nasir, Pearce Christopher, Woodman Richard, Georgiou Andrew
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
Health Sciences Building, College of Medicine and Public, Health Flinders University, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia.
BMC Geriatr. 2023 Feb 24;23(1):111. doi: 10.1186/s12877-023-03821-5.
Opioid use is common among adults 65 years and older, while long-term use of opioids remains controversial and poses risks of drug dependence and other adverse events. The acute disease caused by the SARS-CoV-2 (COVID-19) pandemic has created new challenges and barriers to healthcare access, particularly for long-term care residents. Australia had a relatively low incidence and deaths due to COVID-19 during the first year of the pandemic compared to most OECD countries. In this context, we examined opioid prescribing rates and their dosage in residential aged care facilities (RACFs) before (2019) and during the COVID-19 pandemic (2020) from March to December in Australia.
We conducted a retrospective cohort using general practice electronic health records. This includes 17,304 RACF residents aged 65 years and over from 361 general practices in New South Wales and Victoria. Number of opioid prescriptions and percentage of opioids over 50 mg/day of oral morphine equivalent (OME) were described. Multivariate generalized estimating equations were applied to estimate odds ratios [aORs (95% confidence intervals)] for 1) opioids prescribed per consultation and 2) prescription opioids over 50 mg/day OME.
In 2020 among 11,154 residents, 22.8% of 90,897 total prescriptions were opioids, and of the opioids, 11.3% were over 50 mg/day OME. In 2019 among 10,506 residents, 18.8% of 71,829 total prescriptions were opioids, of which 10.3% were over 50 mg/day OME. Year [2020 vs. 2019: aOR (95% CI):1.50 (1.44, 1.56); 1.29 (1.15, 1.46)] and regionality [rural/regional vs. metropolitan: 1.37 (1.26, 1.49); 1.40 (1.14, 1.71)] were associated with higher odds of prescription opioids and OME > 50 mg/day, respectively. Similar results were found when limited to the same residents (n = 7,340) recorded in both years.
Higher prescription rates of opioids were observed during the COVID-19 pandemic in 2020 than in 2019 in Australian RACFs. The higher odds of prescription opioids and higher dosing in rural/regional than metropolitan areas indicate a widening of the gap in the quality of pain management during the pandemic. Our findings contribute to the limited data that indicate increased opioid prescriptions in long-term care facilities, likely to continue while COVID-19 pandemic restrictions remain.
阿片类药物在65岁及以上成年人中使用普遍，而长期使用阿片类药物仍存在争议，并存在药物依赖和其他不良事件的风险。严重急性呼吸综合征冠状病毒2（SARS-CoV-2，即新型冠状病毒肺炎）大流行引发的急性疾病给医疗服务的获取带来了新的挑战和障碍，尤其是对长期护理机构的居民而言。与大多数经合组织国家相比，在大流行的第一年，澳大利亚因新型冠状病毒肺炎导致的发病率和死亡率相对较低。在此背景下，我们研究了澳大利亚2019年（疫情前）以及2020年3月至12月新型冠状病毒肺炎大流行期间，老年护理机构（RACFs）中阿片类药物的处方率及其剂量。
我们使用全科医疗电子健康记录进行了一项回顾性队列研究。这包括来自新南威尔士州和维多利亚州361家全科医疗诊所的17304名65岁及以上的老年护理机构居民。描述了阿片类药物处方数量以及口服吗啡当量（OME）超过50毫克/天的阿片类药物百分比。应用多变量广义估计方程来估计1）每次会诊开具的阿片类药物和2）OME超过50毫克/天的处方阿片类药物的比值比[aORs（95%置信区间）]。
2020年，在11154名居民中，90897份总处方中有22.8%为阿片类药物，其中11.3%的阿片类药物OME超过50毫克/天。2019年，在10506名居民中，71829份总处方中有18.8%为阿片类药物，其中10.3%的阿片类药物OME超过50毫克/天。年份[2020年与2019年：aOR（95%CI）：1.50（1.44，1.56）；1.29（1.15，1.46）]和地区性[农村/地区与大都市地区：1.37（1.26，1.49）；1.40（1.14，1.71）]分别与开具处方阿片类药物和OME>50毫克/天的较高比值比相关。当仅限于两年都有记录的相同居民（n = 7340）时，也发现了类似结果。
2020年新型冠状病毒肺炎大流行期间，澳大利亚老年护理机构中阿片类药物的处方率高于2019年。农村/地区开具处方阿片类药物的较高比值比以及比大都市地区更高的剂量表明，大流行期间疼痛管理质量的差距在扩大。我们的研究结果为有限的数据提供了补充，这些数据表明长期护理机构中阿片类药物处方增加，在新型冠状病毒肺炎大流行限制措施仍然存在的情况下可能会持续。
