均衡阿片类药物倡议的预算影响分析:一个集群随机试验,旨在在初级保健机构处方阿片类药物治疗慢性疼痛
Andrew Quanbeck1, Xiang Li2,3, Andrew Cohen4
1Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin andrew.quanbeck@fammed.wisc.edu.
Annals of family medicine
|January 26, 2026
概括
实施更高强度的撤销策略有效降低了阿片类药物剂量和改善了疼痛查. 然而,成本最低的系统层面方法对预算产生了最大的影响,这表明联合策略在减少阿片类药物依赖方面更具成本效益.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 实施科学 实施科学
- 疼痛管理 疼痛管理
背景情况:
- 阿片类药物处方指南旨在减少与长期阿片类药物治疗相关的风险.
- 撤销实施策略对于消除不符合指南的做法至关重要.
- 了解不同实施方法对预算的影响对于医疗保健系统至关重要.
研究的目的:
- 为了比较四个消除实施策略的预算影响,以促进与指南一致的阿片类药物处方.
- 评估系统级,诊所级和处方者级干预措施的成本效益.
主要方法:
- 进行了一项集群随机试验,涉及32个初级保健诊所.
- 实施了四种撤销策略:系统,系统+诊所,系统+处方者和系统+诊所+处方者.
- 结果包括改变吗啡毫克相当剂量和遵守阿片类药物风险减轻指标的变化,以及成本分析.
主要成果:
- 实施成本因战略而异,从每家诊所的4416美元到8358美元不等.
- 在考虑医疗保健利用时,仅系统策略的预算影响最高 (10,908美元),而系统+诊所策略的预算影响最低 (7266美元).
- 高强度策略显著降低了阿片类药物剂量,增加了疼痛/功能查.
结论:
- 尽管初始成本较低,但单一系统层面的撤销策略,由于医疗保健利用率增加,导致了最大的整体预算影响.
- 将系统层面的策略与临床和处方者层面的干预措施相结合,在减少阿片类药物依赖和减轻预算影响方面可能更具成本效益.
- 这些发现表明,多层次的取消实施方法对于优化阿片类药物处方和管理医疗保健成本是有价值的.
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