Sim Yongbo, Hausberger Clayton F, Wang Junling
Department of Economics, City University of New York, New York, NY, United States.
Department of Clinical Pharmacy & Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, United States.
J Pharm Health Serv Res. 2024 Feb 28;15(1):rmae002. doi: 10.1093/jphsr/rmae002. eCollection 2024 Mar.
This study examined the effects of the comprehensive medication review of Medicare medication therapy management programs on opioid overuse among Medicare beneficiaries.
This retrospective study analyzed Medicare data from 2016 to 2017. The intervention group included Medicare beneficiaries who newly received comprehensive medication review in 2017; the control group referred to patients who met the general eligible criteria for the medication therapy management program but did not enroll in 2016 or 2017. Propensity score matching was performed to increase characteristic compatibility between the intervention and control groups. Three measures of opioid overuse were analyzed: use of opioids at a high dosage, use of opioids from multiple providers, and concurrent use of opioids and benzodiazepines. The effects of comprehensive medication review on opioid overuse were analyzed with a multivariate logistic regression with an interaction term between the receipt of comprehensive medication review and the year 2017.
The proportion of concurrent use of opioids and benzodiazepines declined at a greater rate among the recipients (2.21%) than non-recipients (1.55%) of the comprehensive medication review. In the adjusted analysis, the odds ratio of no concurrent use of opioids and benzodiazepines was 5% higher (1.05; 95% confidence interval = 1.02-1.09) among recipients than non-recipients. These significant findings were not found for the other two measures of opioid overuse.
Comprehensive medication review is associated with reduced concurrent use of opioids and benzodiazepines among Medicare beneficiaries. Such service should be incorporated into the current approaches for addressing the opioid epidemic.
本研究考察了医疗保险药物治疗管理项目的综合药物审查对医疗保险受益人中阿片类药物过度使用的影响。
这项回顾性研究分析了2016年至2017年的医疗保险数据。干预组包括2017年新接受综合药物审查的医疗保险受益人；对照组指符合药物治疗管理项目一般合格标准但在2016年或2017年未登记参加的患者。进行倾向得分匹配以提高干预组和对照组之间的特征兼容性。分析了阿片类药物过度使用的三项指标：高剂量使用阿片类药物、从多个供应商处使用阿片类药物以及同时使用阿片类药物和苯二氮䓬类药物。采用多变量逻辑回归分析综合药物审查对阿片类药物过度使用的影响，并加入综合药物审查与2017年之间的交互项。
在接受综合药物审查的人群中，阿片类药物与苯二氮䓬类药物同时使用的比例下降速度（2.21%）高于未接受审查的人群（1.55%）。在调整分析中，接受审查者中未同时使用阿片类药物和苯二氮䓬类药物的比值比比未接受审查者高5%（1.05；95%置信区间=1.02-1.09）。在阿片类药物过度使用的其他两项指标上未发现这些显著结果。
综合药物审查与医疗保险受益人中阿片类药物和苯二氮䓬类药物同时使用的减少有关。此类服务应纳入当前应对阿片类药物流行的方法中。
