Punjabi Gary, Ramírez Elena
Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain.
Pharmaceuticals (Basel). 2024 Nov 28;17(12):1609. doi: 10.3390/ph17121609.
: This study evaluated the appropriateness of transmucosal immediate-release fentanyl (TIRF) prescriptions in a Madrid emergency room during 2019 and 2022, following a 2018 warning about off-label use. : TIRF prescription in the emergency room search yielded 993 patients in 2019 and 1499 in 2022, of which 140 were randomized for the study, 70 in 2019, and 70 in 2022. Dose appropriateness and indication for TIRF were analyzed according to established criteria. : Despite a high prevalence of cancer diagnoses (77.9%, 109/140), only 32.9% (46/140) of patients met the appropriateness criteria pre-hospitalization. This improved to 42.5% (51/120) at discharge, but the change was not statistically significant overall. However, focusing on surviving patients reveals a significant improvement in appropriateness, increasing from 30.83% (37/120) to 42.50% ( = 0.002). This improvement was particularly pronounced in 2022 ( = 0.0269), but not in 2019 ( = 0.0771). Interestingly, appropriateness in patients with prior TIRF prescriptions remained relatively stable from pre-hospitalization (46.75%) to discharge (48.78%). A concerningly high proportion of patients with cancer diagnoses (68.75%) received low-dose opioid therapy (<60 MME) at discharge, and 36.8% of patients over 80 years old were co-prescribed benzodiazepines, contradicting prescribing guidelines. : This study found inappropriate TIRF prescriptions were common in an emergency room setting, often due to low pre-hospital opioid doses. While hospitalization improved TIRF appropriateness in survivors, especially in 2022, concerning prescribing practices persisted. This emphasizes the need for better education and interventions to ensure safe and effective TIRF use.
本研究评估了2019年至2022年期间，在马德里一家急诊室中，经黏膜速释芬太尼（TIRF）处方的合理性，该研究是在2018年发出关于标签外使用的警告之后进行的。在急诊室搜索TIRF处方发现，2019年有993名患者，2022年有1499名患者，其中140名被随机纳入研究，2019年70名，2022年70名。根据既定标准分析了TIRF的剂量合理性和适应证。尽管癌症诊断的患病率很高（77.9%，109/140），但只有32.9%（46/140）的患者在入院前符合合理性标准。出院时这一比例提高到42.5%（51/120），但总体变化无统计学意义。然而，关注存活患者发现合理性有显著改善，从30.83%（37/120）增至42.50%（P = 0.002）。这种改善在2022年尤为明显（P = 0.0269），但在2019年不明显（P = 0.0771）。有趣的是，之前有TIRF处方的患者从入院前（46.75%）到出院时（48.78%）合理性保持相对稳定。令人担忧的是，有癌症诊断的患者中，相当高比例（68.75%）在出院时接受了低剂量阿片类药物治疗（<60 MME），80岁以上患者中有36.8%同时开具了苯二氮䓬类药物，这与处方指南相悖。本研究发现，在急诊室环境中，不适当的TIRF处方很常见，通常是由于入院前阿片类药物剂量较低。虽然住院改善了存活患者中TIRF的合理性，尤其是在2022年，但令人担忧的处方做法仍然存在。这强调了需要更好的教育和干预措施，以确保TIRF的安全有效使用。
