对神经病,头痛和腰部疼痛的处方阿片类药物启动:一项基于美国人口的医疗保险研究
Chun Chieh Lin1, Brian C Callaghan2, James F Burke3
1Department of Neurology, The Ohio State University, Columbus, Ohio; Health Services Research Program, Department of Neurology, University of Michigan, Ann Arbor, Michigan.
The journal of pain
|July 19, 2023
概括
治疗神经病,头痛和腰部疼痛等常见疼痛症状的阿片类药物处方在2010-2017年期间有所减少. 更多的专家,如神经病学家和足科医生,与较低的阿片类药物启动率有关.
科学领域:
- 疼痛管理 疼痛管理
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 神经病,头痛和腰部疼痛 (LBP) 是普遍存在的疾病,需要有效的疼痛管理策略.
- 了解影响阿片类药物处方的因素,特别是对于未使用阿片类药物的人来说,对于公共卫生倡议至关重要.
- 专家获取对这些常见疼痛症状的阿片类药物启动的影响仍未得到充分研究.
研究的目的:
- 为了确定与阿片类药物启动相关的因素,在阿片类药物未使用过的老年人中诊断出神经病变,头痛或LBP.
- 评估如何获得特定的医疗专家影响阿片类药物处方模式对这些条件.
主要方法:
- 从2010年到2017年,使用20%的医疗保险样本进行了回顾性队列研究.
- 阿片类药物启动定义为诊断后12个月内填写的第一个阿片类药物处方.
- 用通用估计方程进行后勤回归分析了患者人口统计学,提供者类型和区域医生专业密度.
主要成果:
- 2010年至2017年期间,神经病变,头痛和腰痛的阿片类药物启动率显著下降.
- 与疾病相关的阿片类药物开始也减少了,5-10%的初始处方导致慢性使用.
- 一个地区的神经科医生和足科医生的密度增加与特定疾病相关的阿片类药物启动率较低相关.
结论:
- 专家访问和更多的区域专家访问与开始为常见疼痛条件开处方阿片类药物的可能性降低有关.
- 研究结果表明,加强对专家的接触可能是进一步减少阿片类药物使用的可行策略.
- 未来的干预措施可以集中在促进替代治疗和改善服务不足地区的专家可访问性.
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