医疗保险覆盖的长期阿片类药物治疗老年患者中阿片类药物与精神药物的联合处方。

Coprescribing of opioids and psychotropic medications among Medicare-enrolled older adults on long-term opioid therapy.

出版信息

J Am Pharm Assoc (2003). 2023 Nov-Dec;63(6):1753-1760.e5. doi: 10.1016/j.japh.2023.08.019. Epub 2023 Aug 24.

DOI:10.1016/j.japh.2023.08.019

Abstract

BACKGROUND

Pressures to reduce opioid prescribing have potential to incentivize coprescribing of opioids (at lower dose) with psychotropic medications. Evidence concerning the extent of the problem is lacking. This study assessed trends in coprescribing and characterized coprescribing patterns among Medicare-enrolled older adults with chronic noncancer pain (CNCP) receiving long-term opioid therapy (LTOT).

METHODS

A cohort study was conducted using 2012-2018 5% National Medicare claims data. Eligible beneficiaries were continuously enrolled and had no claims for cancer diagnoses or hospice use, and ≥ 2 claims with diagnoses for CNCP conditions within a 30-day period in the 12 months before the index date (LTOT initiation). Coprescribing was defined as an overlap between opioids and any class of psychotropic medication (antidepressants, benzodiazepines, antipsychotics, anticonvulsants, muscle relaxants, and nonbenzodiazepine hypnotics) based on their prescription fill dates and days of supply in a given year. The occurrence of coprescribing, coprescribing intensity, and number of days of overlap with psychotropic medications were calculated for each calendar year.

RESULTS

The eligible study population of individuals on LTOT ranged from 2038 in 2013 to 1751 in 2018. The occurrence of coprescribing among eligible beneficiaries decreased from 73.41% in 2013 to 70.81% in 2015 and then increased slightly to 71.22% in 2018. Among eligible beneficiaries with at least one overlap day, the coprescribing intensity with any class of psychotropic medications showed minimal variation throughout the study period: 74.73% in 2013 and 72.67% in 2018. Across all the years, the coprescribing intensity was found to be highest with antidepressants (2013, 49.90%; 2018, 50.33%) followed by benzodiazepines (2013, 25.42%; 2018, 19.95%).

CONCLUSION

Coprescribing was common among older adults with CNCP who initiated LTOT but did not rise substantially in the period studied. Future research should investigate drivers behind coprescribing and safety of various patterns of use.

摘要

背景

减少阿片类药物处方的压力可能会促使医生开低剂量的阿片类药物与精神药物同时处方。目前缺乏有关这一问题严重程度的证据。本研究评估了共同处方的趋势，并描述了接受长期阿片类药物治疗（LTOT）的慢性非癌痛（CNCP）老年医疗保险参保者的共同处方模式。

方法

使用 2012-2018 年 5%的国家医疗保险索赔数据进行队列研究。合格的受益人连续参保，且在索引日期（LTOT 开始）前的 12 个月内没有癌症诊断或临终关怀使用的索赔，并且在 30 天内有≥2 次 CNCP 疾病的诊断索赔。共同处方是根据处方填写日期和当年的供应天数，将阿片类药物与任何一类精神药物（抗抑郁药、苯二氮䓬类、抗精神病药、抗惊厥药、肌肉松弛剂和非苯二氮䓬类催眠药）重叠定义的。计算了每个日历年内共同处方的发生情况、共同处方强度和与精神药物重叠的天数。

结果

LTOT 合格研究人群在 2013 年为 2038 人，2018 年为 1751 人。合格受益人的共同处方发生率从 2013 年的 73.41%下降到 2015 年的 70.81%，然后略有上升，到 2018 年达到 71.22%。在至少有一天重叠的合格受益人中，与任何一类精神药物的共同处方强度在整个研究期间变化很小：2013 年为 74.73%，2018 年为 72.67%。在所有年份中，与抗抑郁药的共同处方强度最高（2013 年，49.90%；2018 年，50.33%），其次是苯二氮䓬类（2013 年，25.42%；2018 年，19.95%）。