Morrison R E, Brint J M, Smith W R, Arheart K L, Wray D, Palte S B, Ackerman T F
Department of Medicine, University of Tennessee, Memphis 38103.
J Gen Intern Med. 1994 Jun;9(6):301-5. doi: 10.1007/BF02599175.
To assess the appropriateness of narcotic-prescribing practices in an ambulatory clinic for patients infected with HIV.
DESIGN, SETTING, AND PATIENTS: The medical records of 220 (190 HIV-positive) patients, seen in a clinic primarily designed for the long-term follow-up of ambulatory HIV-infected patients and located in an inner-city, public teaching hospital, were retrospectively reviewed to determine the prevalence and appropriateness of prescribing Drug Enforcement Administration schedule 2 narcotics. Appropriateness was based on published guidelines for the use of narcotics in the treatment of cancer patients.
The prevalence of narcotic use among the HIV-positive patients was 15%. Narcotics were prescribed for 38% of the patients who died, 33% of those with AIDS [Centers for Disease Control and Prevention (CDC) clinical class C], 4% of those with AIDS-related complex (ARC) (CDC clinical class B), and 5% of asymptomatic HIV-positive patients (CDC clinical class A). None of the HIV-negative patients seen in the clinic received narcotics. Narcotics were more likely to be prescribed for patients with AIDS than for patients with ARC (p < 0.001) or for HIV-positive patients (p < 0.001). For the three CDC clinical classes, there was no significant difference among the proportions of patients receiving narcotics inappropriately (p = 0.108). Among the risk groups, intravenous drug abusers were more likely to be prescribed narcotics inappropriately than were men who were homosexual (p < 0.001) or individuals who were heterosexual (p = 0.013); transfusion recipients were also more likely to be prescribed narcotics inappropriately than were homosexual men (p = 0.026) or heterosexual men or women (p = 0.032). Narcotics were more likely to be prescribed for patients with disseminated histoplasmosis (p = 0.022), Pneumocystis carinii pneumonia (p = 0.001), candidal esophagitis (p = 0.020), Kaposi's sarcoma (p < 0.001), or wasted appearance (p = 0.043). Inappropriate prescriptions were more likely to be given to patients with dementia (p = 0.005) or wasted appearance (p = 0.019).
Physicians tend to prescribe narcotics inappropriately to patients known to have previously abused drugs and to those who appear wasted or have dementia. Physicians have a duty to prescribe narcotics appropriately as guided by recognized medical indications and the patients' views concerning their current medical needs.
评估一家门诊诊所针对感染HIV患者开具麻醉药品处方的合理性。
设计、场所与患者：回顾性审查了220名患者（190名HIV阳性）的病历，这些患者来自一家主要为门诊HIV感染患者提供长期随访服务、位于市中心的公立教学医院的诊所，以确定开具美国药品管理局2类麻醉药品的普遍性及合理性。合理性依据已发表的关于麻醉药品用于癌症患者治疗的指南。
HIV阳性患者中麻醉药品的使用率为15%。在死亡患者中，38%的患者开具了麻醉药品；患有艾滋病[疾病控制与预防中心（CDC）临床分级C级]的患者中，33%开具了麻醉药品；患有艾滋病相关综合征（ARC）（CDC临床分级B级）的患者中，4%开具了麻醉药品；无症状HIV阳性患者（CDC临床分级A级）中，5%开具了麻醉药品。诊所中未见HIV阴性患者使用麻醉药品。与患有ARC的患者（p<0.001）或HIV阳性患者（p<0.001）相比，艾滋病患者更有可能被开具麻醉药品。对于CDC的三个临床分级，接受不适当麻醉药品处方的患者比例之间无显著差异（p = 0.108）。在风险组中，静脉吸毒者比同性恋男性（p<0.001）或异性恋者（p = 0.013）更有可能被不适当开具麻醉药品；输血接受者也比同性恋男性（p = 0.026）或异性恋男性或女性（p = 0.032）更有可能被不适当开具麻醉药品。播散性组织胞浆菌病患者（p = 0.022）、卡氏肺孢子虫肺炎患者（p = 0.001）、念珠菌性食管炎患者（p = 0.020）、卡波西肉瘤患者（p<0.001）或有消瘦外观的患者（p = 0.043）更有可能被开具麻醉药品。不适当的处方更有可能开给患有痴呆症的患者（p = 0.005）或有消瘦外观的患者（p = 0.019）。
医生往往会不恰当地给已知有药物滥用史的患者以及那些有消瘦外观或患有痴呆症的患者开具麻醉药品。医生有责任根据公认的医学指征以及患者对其当前医疗需求的看法，恰当地开具麻醉药品。
