Koch Nancy V, Butterfield Richard J
Division of General Internal Medicine, Mayo Clinic, Scottsdale, AZ.
Division of Clinical Trials and Biostatistics, Mayo Clinic, Scottsdale, AZ.
Mayo Clin Proc Innov Qual Outcomes. 2023 Aug 21;7(5):366-372. doi: 10.1016/j.mayocpiqo.2023.07.008. eCollection 2023 Oct.
To determine risk factors for nonelective emergency department visits NEDVs) and whether primary care visits incorporating risk mitigation tools prevented NEDVs among patients using long-term opioid therapy (LOT).
We retrospectively searched the electronic health records at Mayo Clinic primary care outpatient practices in Arizona and Florida in all of 2018 and 2019 for the records of individual adult patients using LOT. Patient and clinician demographic characteristics and patient risk factors were compared between patients with and without risk mitigation visits. Univariate and multivariable logistic regression was used to determine risk factors for NEDVs.
Among 457 patients using LOT identified during the study period, most were women (n=266, 58.2%), and the median age was 69 years. Long-term opioid therapy risk mitigation visits were performed equally by family medicine and internal medicine clinicians and by a significantly higher proportion of Florida clinicians than Arizona clinicians (87.0% vs 70.5%; <.001). Older age, falls, and mental health care utilization all increased the risk of NEDVs. Risk mitigation visits were protective against NEDVs (odds ratio, 0.56; 95% CI, 0.35-0.89; =.01) after adjustment for older age, falls, and mental health care utilization.
Risk mitigation visits are effective in preventing NEDVs, and all patients using LOT should have such visits when possible.
确定非选择性急诊科就诊（NEDV）的风险因素，以及纳入风险缓解工具的初级保健就诊是否能预防长期使用阿片类药物治疗（LOT）患者的NEDV。
我们回顾性检索了2018年全年及2019年梅奥诊所位于亚利桑那州和佛罗里达州的初级保健门诊的电子健康记录，以获取使用LOT的成年患者个体记录。比较了有和没有进行风险缓解就诊的患者的患者和临床医生人口统计学特征及患者风险因素。采用单因素和多因素逻辑回归确定NEDV的风险因素。
在研究期间确定的457例使用LOT的患者中，大多数为女性（n = 266，58.2%），中位年龄为69岁。家庭医学和内科临床医生进行长期阿片类药物治疗风险缓解就诊的比例相同，且佛罗里达州临床医生进行此类就诊的比例显著高于亚利桑那州临床医生（87.0%对70.5%；P <.001）。年龄较大、跌倒和使用精神卫生保健均增加了NEDV的风险。在对年龄较大、跌倒和使用精神卫生保健进行调整后，风险缓解就诊可预防NEDV（比值比，0.56；95%置信区间，0.35 - 0.89；P =.01）。
风险缓解就诊可有效预防NEDV，所有使用LOT的患者应尽可能进行此类就诊。
