在澳大利亚初级保健中持续使用阿片类药物的预测因素:回顾性队列研究,2018-2022年
Monica Jung1,2, Ting Xia1, Jenni Ilomäki2,3
1Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.
Pain medicine (Malden, Mass.)
|August 7, 2024
概括
高龄,物质使用障碍,慢性疼痛以及对 gabapentinoids, benzodiazepines 和 z-drugs 的同时处方预测了澳大利亚初级保健中持续使用阿片类药物的情况. 这些因素对于安全的阿片类药物处方至关重要.
科学领域:
- 药理学和药理学流行病学
- 初级医疗保健医学 一级医疗保健医学
- 疼痛管理 疼痛管理
背景情况:
- 持续使用阿片类药物,定义为长期依赖阿片类止痛药,构成重大公共卫生挑战.
- 确定持续使用阿片类药物的预测因素对于开发有针对性的干预措施和确保初级保健机构安全的处方实践至关重要.
研究的目的:
- 在澳大利亚初级保健中调查与持续使用阿片类药物相关的个人层面的因素,在开始治疗非癌症疼痛的阿片类药物治疗的患者中.
- 确定可以为临床决策和阿片类药物处方风险分层提供信息的关键预测因素.
主要方法:
- 一项回顾性队列研究,利用澳大利亚初级保健中的人口水平分析和报告 (POLAR) 数据库.
- 分析包括在2018年至2022年期间处方阿片类止痛药的343,023人,持久性根据特定的处方持续时间和差距标准来定义.
- 采用多变量逻辑回归模型来确定持续使用阿片类药物的各种预测因素的调整赔率比率.
主要成果:
- 在343,023人中,4.8% (16,527) 的人持续使用阿片类药物.
- 重要预测因素包括年龄较大 (≥75岁),优惠受益者身份,被诊断为物质使用障碍和慢性疼痛.
- 开始使用布普伦诺芬或长效阿片类药物,较高的初始阿片类药物量,在开始时重复处方,以及 gabapentinoids, benzodiazepines 和 z 药物的联合处方也与持久性有很强的关联.
结论:
- 这项研究确定了澳大利亚初级保健中非癌症疼痛患者持续使用阿片类药物的几种个人级别风险因素.
- 这些发现突显出需要进一步研究与这些风险因素相关的临床结果.
- 这些结果支持制定更安全,更有效的阿片类药物处方策略,特别是在风险患者群体中.
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