养老院居民中短期阿片类药物升级与长效阿片类药物起始治疗的效果比较。
Effectiveness of Short-Acting Opioid Escalation vs Initiation of a Long-Acting Opioid in Nursing Home Residents.
机构信息
Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA.
Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA.
出版信息
J Am Med Dir Assoc. 2024 Sep;25(9):105077. doi: 10.1016/j.jamda.2024.105077. Epub 2024 Jun 8.
OBJECTIVES
Modifications to opioid regimens for persistent pain are typically made after an initial period of short-acting opioid (SAO) use. Regimen changes may include an escalation of the SAO dosage or an initiation of a long-acting opioid (LAO) as a switch or add-on therapy. This study evaluates the comparative effectiveness between these alternative regimens in nursing home residents.
DESIGN
A retrospective observational cohort analysis of US long-stay nursing home residents.
SETTING AND PARTICIPANTS
Nursing home resident data were obtained from the national Minimum Dataset (MDS) version 3.0 and linked Medicare data, 2011-2016.
METHODS
Opioid regimen changes were identified using Part D dispensing claims to identify dosage escalation of SAOs, initiation of an LAO, or a switch to an LAO. Outcomes included indices of pain occurrence, frequency, and severity reported on the earliest MDS assessment within 3 months following the opioid regimen change. Resident attributes were described by opioid regimen cohort. Prevalence ratios of pain and depression indices were quantified using doubly robust inverse probability of treatment (IPT)-weighted log-binomial regression.
RESULTS
The study cohorts included 2072 SAO dose escalations, 575 LAO add-on initiations, and 247 LAO switch initiations. After IPT weighting, we observed comparable effects on pain and mood across the opioid regimen cohorts. A substantial number of residents continued to report frequent/constant pain (36% in SAO Escalation Cohort, 42% in LAO Add-on Cohort, 42% in the LAO Switch Cohort). The distribution of depressive symptoms was similar regardless of the opioid regimen change.
CONCLUSIONS AND IMPLICATIONS
Initiation of an LAO as an add-on to SAO or a switch from SAO had comparable effects on pain and mood to SAO dose escalation without initiation of an LAO. Although fewer residents reported any pain after the regimen change, persistent pain was reported by most residents.
目的
对于持续性疼痛，通常在短期使用阿片类药物（SAO）初始阶段后，对阿片类药物方案进行调整。方案调整可能包括增加 SAO 剂量或开始使用长效阿片类药物（LAO）作为转换或附加治疗。本研究评估了这些替代方案在养老院居民中的比较效果。
设计
一项针对美国长期居住在养老院居民的回顾性观察队列分析。
设置和参与者
从国家最低数据集（MDS）版本 3.0 和医疗保险数据中获取养老院居民数据，时间范围为 2011-2016 年。
方法
使用处方配药的 Part D 数据来确定 SAO 剂量增加、LAO 起始或转换为 LAO 的阿片类药物方案变化。结果包括在阿片类药物方案变化后 3 个月内最早的 MDS 评估中报告的疼痛发生、频率和严重程度的指标。通过阿片类药物方案队列描述居民特征。使用双重稳健逆概率治疗（IPT）加权对数二项式回归量化疼痛和抑郁指数的患病率比值。
结果
研究队列包括 2072 例 SAO 剂量增加、575 例 LAO 附加起始和 247 例 LAO 转换起始。IPT 加权后，我们观察到在阿片类药物方案队列中，疼痛和情绪的效果相当。相当数量的居民继续报告频繁/持续的疼痛（SAO 增加组 36%，LAO 附加组 42%，LAO 转换组 42%）。无论阿片类药物方案的变化如何，抑郁症状的分布相似。
结论和意义
作为 SAO 的附加治疗或从 SAO 转换开始使用 LAO，与不开始使用 LAO 的情况下增加 SAO 剂量相比，对疼痛和情绪的效果相当。尽管方案变化后报告疼痛的居民较少，但大多数居民仍报告有持续性疼痛。
Zotero 插件