美国疾病预防控制中心 2016 年阿片类药物指南发布前后的阿片类药物处方情况。
Opioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention's 2016 Opioid Guideline.
机构信息
University of Michigan and Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan (A.S.B.).
Centers for Disease Control and Prevention, Atlanta, Georgia (G.P.G., J.L.L.).
出版信息
Ann Intern Med. 2018 Sep 18;169(6):367-375. doi: 10.7326/M18-1243. Epub 2018 Aug 28.
BACKGROUND
In response to adverse outcomes from prescription opioids, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain in March 2016.
OBJECTIVE
To test the hypothesis that the CDC guideline release corresponded to declines in specific opioid prescribing practices.
DESIGN
Interrupted time series analysis of monthly prescribing measures from the IQVIA transactional data warehouse and Real-World Data Longitudinal Prescriptions population-level estimates based on retail pharmacy data. Population size was determined by U.S. Census monthly estimates.
SETTING
United States, 2012 to 2017.
PATIENTS
Persons prescribed opioid analgesics.
MEASUREMENTS
Outcomes included opioid dosage, days supplied, overlapping benzodiazepine prescriptions, and the overall rate of prescribing.
RESULTS
The rate of high-dosage prescriptions (≥90 morphine equivalent milligrams per day) was 683 per 100 000 persons in January 2012 and declined by 3.56 (95% CI, -3.79 to -3.32) per month before March 2016 and by 8.00 (CI, -8.69 to -7.31) afterward. Likewise, the percentage of patients with overlapping opioid and benzodiazepine prescriptions was 21.04% in January 2012 and declined by 0.02% (CI, -0.04% to -0.01%) per month before the CDC guideline release and by 0.08% (CI, -0.08% to -0.07%) per month afterward. The overall opioid prescribing rate was 6577 per 100 000 persons in January 2012 and declined by 23.48 (CI, -26.18 to -20.78) each month before the guideline release and by 56.74 (CI, -65.96 to -47.53) per month afterward.
LIMITATION
No control population; inability to determine the appropriateness of opioid prescribing.
CONCLUSION
Several opioid prescribing practices were decreasing before the CDC guideline, but the time of its release was associated with a greater decline. Guidelines may be effective in changing prescribing practices.
PRIMARY FUNDING SOURCE
CDC.
背景
针对处方类阿片药物的不良后果，疾病预防控制中心（CDC）于 2016 年 3 月发布了《慢性疼痛处方类阿片药物指南》。
目的
验证这一假设，即 CDC 指南的发布与特定类阿片药物处方实践的下降相对应。
设计
对 IQVIA 交易数据仓库的每月处方测量值和基于零售药店数据的真实世界数据纵向处方人群水平估计进行中断时间序列分析。人口规模由美国人口普查的每月估计数决定。
地点
美国，2012 年至 2017 年。
患者
接受阿片类镇痛药处方的患者。
测量
结果包括阿片类药物剂量、供应天数、重叠苯二氮䓬类药物处方和总体处方率。
结果
2012 年 1 月，高剂量处方（≥90 吗啡当量毫克/天）的发生率为每 10 万人中有 683 人，在 2016 年 3 月之前每月下降 3.56（95%置信区间，-3.79 至 -3.32），之后每月下降 8.00（置信区间，-8.69 至 -7.31）。同样，2012 年 1 月有重叠阿片类药物和苯二氮䓬类药物处方的患者百分比为 21.04%，在 CDC 指南发布之前，每月下降 0.02%（置信区间，-0.04% 至 -0.01%），之后每月下降 0.08%（置信区间，-0.08% 至 -0.07%）。2012 年 1 月，每 10 万人中有 6577 人接受阿片类药物处方，在指南发布之前，每月下降 23.48（置信区间，-26.18 至 -20.78），之后每月下降 56.74（置信区间，-65.96 至 -47.53）。
局限性
没有对照人群；无法确定阿片类药物处方的适当性。
结论
在 CDC 指南发布之前，一些阿片类药物的处方做法已经减少，但发布时间与更大的下降相对应。指南可能在改变处方做法方面有效。
主要资金来源
CDC。
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