Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California, USA.
Clin Transl Gastroenterol. 2024 Oct 1;15(10):e1. doi: 10.14309/ctg.0000000000000729.
Opioids are commonly prescribed to patients with chronic liver disease, but little is known regarding medication prescribing patterns of hepatologists. Opioid use increased until national guidelines limited opioid prescriptions in early 2016. We aimed to describe rates of opioid and nonopioid analgesics to Medicare beneficiaries by hepatologists from 2013 to 2017 and identify demographic characteristics associated with higher prescribing.
Prescription data from 2013 to 2017 by 761 hepatologists identified in the Centers for Medicare and Medicaid Services Part D Public Use File were analyzed. Annual prescription volumes were compared for providers with >10 annual prescriptions of a given drug type. Provider characteristics associated with opioid prescriptions were identified through multivariate logistic regression analyses.
The proportion of hepatologists prescribing >10 annual opioid prescriptions decreased from 29% to 20.6%. Median annual opioid prescriptions per hepatologist significantly decreased from 24 to 20. Tramadol remained the most prescribed analgesic. Nonopioid analgesic prescription volume did not increase significantly. Provider characteristics associated with increased opioid prescriptions included male sex, practice location in the South and Midwest (vs West), more years in practice, and a greater proportion of beneficiaries who are white or with low-income subsidy claims. Characteristics associated with fewer prescriptions included non-university-based practice, having a greater proportion of female beneficiaries, and later prescription year.
Hepatologists are prescribing less opioids. However, the prevalence of tramadol use and the lack of increase in nonopioid analgesic use highlights the need for advancing the science and training of pain management in chronic liver disease and targeted implementation of nonopioid treatment programs.
阿片类药物常用于治疗慢性肝病患者，但人们对肝病专家的药物处方模式知之甚少。阿片类药物的使用量一直在增加，直到 2016 年初国家指南限制了阿片类药物的处方。我们旨在描述 2013 年至 2017 年间，肝科医生为医疗保险受益人开阿片类药物和非阿片类药物的情况，并确定与更高处方率相关的人口统计学特征。
从医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）处方数据库（Part D Public Use File）中确定的 761 位肝科医生的 2013 年至 2017 年的处方数据进行分析。对每年开某种药物处方超过 10 次的医生进行比较。通过多变量逻辑回归分析确定与阿片类药物处方相关的医生特征。
每年开 10 次以上阿片类药物处方的医生比例从 29%下降到 20.6%。每位医生的阿片类药物年度处方中位数从 24 张显著下降到 20 张。曲马多仍然是最常开的镇痛药。非阿片类镇痛药的处方量没有显著增加。与阿片类药物处方增加相关的医生特征包括男性、南部和中西部（而非西部）的执业地点、更多的执业年限、以及更多的白人或有低收入补贴申请的受益人群。与开更少阿片类药物处方相关的特征包括非大学执业、女性受益人群比例较高、以及处方年份较晚。
肝科医生开的阿片类药物较少。然而，曲马多的使用仍然很普遍，而非阿片类镇痛药的使用并没有增加，这突出表明需要在慢性肝病的疼痛管理方面推进科学和培训，并实施针对非阿片类药物的治疗方案。
