From the Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois (SNS, SM); The Shirley Ryan AbilityLab, Chicago, Illinois (SNS, MS, CB, SM); and Creighton University Arizona Health Education Alliance, Phoenix, Arizona (NC).
Am J Phys Med Rehabil. 2024 Feb 1;103(2):105-109. doi: 10.1097/PHM.0000000000002305. Epub 2023 Jun 15.
The study aims to determine whether Physical Medicine & Rehabilitation physicians offer naloxone per the Centers for Disease Control and Prevention Guidelines to patients at the highest risk of complications from opioid treatment and whether there is a difference between inpatient and outpatient naloxone prescribing.
A retrospective chart review on 389 adults (outpatient n = 166; inpatient n = 223) from May 4 to May 31, 2022, at an academic rehabilitation hospital. Prescribed medications and comorbidities were evaluated to determine whether Centers for Disease Control and Prevention criteria for offering naloxone were met and whether naloxone was offered.
One hundred twenty-nine opioid prescriptions were written for 102 outpatients; 61 qualified for naloxone (morphine milliequivalent range = 10-1080, mean = 158.08). On inpatient, 68 patients received 86 opioid prescriptions; 35 qualified for naloxone (morphine milliequivalent range = 3.75-246, mean = 62.36). Overall, there was a significantly lower rate of opioid prescriptions for inpatients (30.49%) than outpatients (61.45%) ( P < 0.0001), a nonsignificant lower rate of inpatient (51.47%) than outpatient (59.80%) "at-risk" prescriptions ( P = 0.351), and a weakly significant lower rate of naloxone prescribing for inpatient (2.86%) than outpatient visits (8.20%) ( P < 0.0519).
At this rehabilitation hospital, there was a low rate of naloxone prescribing by inpatient and outpatient providers, with a higher rate occurring in the outpatient than inpatient setting. More research is needed to understand this prescribing trend to determine potential interventions.
本研究旨在确定物理医学与康复医师是否根据疾病控制与预防中心的指南向阿片类药物治疗并发症风险最高的患者提供纳洛酮，以及门诊和住院患者开具纳洛酮之间是否存在差异。
对 2022 年 5 月 4 日至 5 月 31 日在一家学术康复医院就诊的 389 名成年人（门诊患者 n = 166；住院患者 n = 223）进行回顾性图表审查。评估开具的药物和合并症，以确定是否符合疾病控制与预防中心提供纳洛酮的标准以及是否提供了纳洛酮。
102 名门诊患者开具了 129 份阿片类药物处方；61 份符合纳洛酮条件（吗啡毫当量范围=10-1080，平均值=158.08）。在住院患者中，68 名患者开具了 86 份阿片类药物处方；35 份符合纳洛酮条件（吗啡毫当量范围=3.75-246，平均值=62.36）。总体而言，住院患者开具阿片类药物处方的比例（30.49%）明显低于门诊患者（61.45%）（P < 0.0001），住院患者（51.47%）“高危”处方的比例低于门诊患者（59.80%）（P=0.351），住院患者开具纳洛酮的比例（2.86%）明显低于门诊患者（8.20%）（P < 0.0519）。
在这家康复医院，住院和门诊医生开纳洛酮的比例较低，门诊开纳洛酮的比例高于住院。需要进一步研究以了解这种处方趋势，以确定潜在的干预措施。
