Department of Surgery, University of Utah, Salt Lake City, Utah, USA.
Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
Health Serv Res. 2023 Dec;58(6):1256-1265. doi: 10.1111/1475-6773.14227. Epub 2023 Sep 12.
To evaluate a health system-wide intervention distributing free home-disposal bags to surgery patients prescribed opioids.
We collected patient surveys and electronic medical record data at an academic health system.
We conducted a prospective observational study. The bags were primarily distributed at pharmacies, though pharmacists delivered bags to some patients. The primary outcome was disposal of leftover opioids (effectiveness). Secondary outcomes were patient willingness to dispose and factors associated with disposal (effectiveness), recalling receipt of the bag (reach), and recalling receipt of bags and disposal over time (maintenance). We used a modified Poisson regression to evaluate the relative risk of disposal. Inverse probability of treatment weighting, based on propensity scores, was used to account for differences between survey responders and non-responders and reduce nonresponse bias.
DATA COLLECTION/EXTRACTION METHODS: From August 2020 to May 2021, we surveyed patients 2 weeks after discharge (allowing for home opioid use). Eligibility criteria were age ≥18, English being primary language, valid email address, hospitalization ≤30 days, discharge home, and an opioid prescription sent to a system pharmacy.
We identified 5134 patients with 2174 completing the survey (response rate 42.3%). Among respondents, 1375 (63.8%) recalled receiving the disposal bag. Among 1075 respondents with leftover opioids, 284 (26.4%) disposed, 552 (51.3%) planned to dispose, 79 (7.4%) did not plan to dispose, 69 (6.4%) had undecided, and 91 (8.5%) had not considered disposal. Recalling receipt of the bag (incidence rate ratio [IRR] 1.25, 95% confidence interval [CI] 1.13-1.37) was positively associated with disposal. Patients who used opioids in the last year were less likely to dispose (IRR 0.82, 95% CI 0.73-0.93). Disposal rates remained stable over the study period while recalling receipt of bags trended up.
A pragmatic implementation of a disposal intervention resulted in lower disposal rates than prior trials.
评估一项向开处阿片类药物的手术患者免费发放家庭处理袋的全系统卫生干预措施。
我们在一个学术医疗系统收集了患者调查和电子病历数据。
我们进行了一项前瞻性观察性研究。这些袋子主要在药房发放，但药剂师也会将袋子送到一些患者手中。主要结局是处理剩余阿片类药物的情况（效果）。次要结局是患者愿意处理和与处理相关的因素（效果）、回忆收到袋子的情况（覆盖范围）以及随着时间的推移回忆收到袋子和处理的情况（维持）。我们使用修正后的泊松回归来评估处理的相对风险。基于倾向评分的逆概率治疗加权用于说明调查应答者和非应答者之间的差异，并减少无应答偏倚。
数据收集/提取方法：从 2020 年 8 月至 2021 年 5 月，我们在出院后 2 周对患者进行了调查（允许在家中使用阿片类药物）。入选标准为年龄≥18 岁、英语为主要语言、有有效的电子邮件地址、住院时间≤30 天、出院回家、并向系统药房开出阿片类药物处方。
我们确定了 5134 名患者，其中 2174 名完成了调查（应答率 42.3%）。在应答者中，1375 名（63.8%）回忆收到了处理袋。在 1075 名有剩余阿片类药物的应答者中，284 名（26.4%）进行了处理，552 名（51.3%）计划进行处理，79 名（7.4%）不打算处理，69 名（6.4%）未作决定，91 名（8.5%）未考虑处理。回忆收到袋子（发病率比 [IRR] 1.25，95%置信区间 [CI] 1.13-1.37）与处理呈正相关。在过去一年中使用过阿片类药物的患者不太可能进行处理（IRR 0.82，95%CI 0.73-0.93）。在研究期间，处理率保持稳定，而回忆收到袋子的趋势上升。
一项实用的处理干预措施的实施导致的处理率低于先前的试验。
