纳洛酮联合处方用于接受长期阿片类药物治疗疼痛的初级保健患者的非随机干预研究
Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain.
作者信息
Coffin Phillip O, Behar Emily, Rowe Christopher, Santos Glenn-Milo, Coffa Diana, Bald Matthew, Vittinghoff Eric
出版信息
Ann Intern Med. 2016 Aug 16;165(4):245-52. doi: 10.7326/M15-2771. Epub 2016 Jun 28.
BACKGROUND
Unintentional overdose involving opioid analgesics is a leading cause of injury-related death in the United States.
OBJECTIVE
To evaluate the feasibility and effect of implementing naloxone prescription to patients prescribed opioids for chronic pain.
DESIGN
2-year nonrandomized intervention study.
SETTING
6 safety-net primary care clinics in San Francisco, California.
PARTICIPANTS
1985 adults receiving long-term opioid therapy for pain.
INTERVENTION
Providers and clinic staff were trained and supported in naloxone prescribing.
MEASUREMENTS
Outcomes were proportion of patients prescribed naloxone, opioid-related emergency department (ED) visits, and prescribed opioid dose based on chart review.
RESULTS
38.2% of 1985 patients receiving long-term opioids were prescribed naloxone. Patients prescribed higher doses of opioids and with an opioid-related ED visit in the past 12 months were independently more likely to be prescribed naloxone. Patients who received a naloxone prescription had 47% fewer opioid-related ED visits per month in the 6 months after receipt of the prescription (incidence rate ratio [IRR], 0.53 [95% CI, 0.34 to 0.83]; P = 0.005) and 63% fewer visits after 1 year (IRR, 0.37 [CI, 0.22 to 0.64]; P < 0.001) compared with patients who did not receive naloxone. There was no net change over time in opioid dose among those who received naloxone and those who did not (IRR, 1.03 [CI, 0.91 to 1.27]; P = 0.61).
LIMITATION
Results are observational and may not be generalizable beyond safety-net settings.
CONCLUSION
Naloxone can be coprescribed to primary care patients prescribed opioids for pain. When advised to offer naloxone to all patients receiving opioids, providers may prioritize those with established risk factors. Providing naloxone in primary care settings may have ancillary benefits, such as reducing opioid-related adverse events.
PRIMARY FUNDING SOURCE
National Institutes of Health.
背景
在美国，涉及阿片类镇痛药的意外过量是与伤害相关死亡的主要原因。
目的
评估对因慢性疼痛而开具阿片类药物的患者实施纳洛酮处方的可行性和效果。
设计
为期2年的非随机干预研究。
地点
加利福尼亚州旧金山的6家安全网初级保健诊所。
参与者
1985名接受长期阿片类药物治疗疼痛的成年人。
干预措施
对医护人员进行纳洛酮处方方面的培训并提供支持。
测量指标
通过病历审查得出开具纳洛酮的患者比例、与阿片类药物相关的急诊科就诊情况以及开具的阿片类药物剂量。
结果
1985名接受长期阿片类药物治疗的患者中，38.2%的患者开具了纳洛酮。过去12个月内开具较高剂量阿片类药物且有与阿片类药物相关的急诊科就诊经历的患者，单独开具纳洛酮的可能性更大。与未接受纳洛酮的患者相比，接受纳洛酮处方的患者在收到处方后的6个月内，每月与阿片类药物相关的急诊科就诊次数减少了47%（发病率比[IRR]，0.53[95%置信区间，0.34至0.83]；P = 0.005），1年后就诊次数减少了63%（IRR，0.37[置信区间，0.22至0.64]；P < 0.001）。接受纳洛酮和未接受纳洛酮的患者，阿片类药物剂量随时间没有净变化（IRR，1.03[置信区间，0.91至1.27]；P = 0.61）。
局限性
结果是观察性的，可能无法推广到安全网环境之外。
结论
纳洛酮可以与为疼痛开具阿片类药物的初级保健患者同时开具。当建议为所有接受阿片类药物的患者提供纳洛酮时，医护人员可以优先考虑那些有既定风险因素的患者。在初级保健环境中提供纳洛酮可能有附带益处，比如减少与阿片类药物相关的不良事件。
主要资金来源
美国国立卫生研究院。
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