美国斯坦福大学医学院Mathew V Kiang研究组宣布他们对2003-2017年间美国医疗机构阿片类药物的处方模式进行了回顾性观察研究。相关论文于2020年1月29日发表于国际顶尖学术期刊《英国医学杂志》上。

为了了解美国阿片类药物处方分布及用药模式，研究组设计了一项回顾性观察研究，涉及国家私人保险覆盖的全美50个州和华盛顿特区。

2003-2017年，每年平均有669495家医疗机构向390万患者开出890万张阿片类处方。2017年，前1%的医疗结构占所有阿片类药物用量的49%，占所有阿片类药物处方的27%。

按绝对值计算，排名前1%的医疗机构开的处方平均为748000吗啡毫克当量（MMEs），是排名中间1%的医疗机构的近1000倍。在1年内排名前1%的医疗机构中，至少一半在接下来的几年里也在排名前1%。

超过五分之二的处方是由前1%的医疗机构开的，每天超过50MMEs，超过五分之四的处方用药时间超过七天。相比之下，99%的药剂师开出的处方低于这些阈值，86%的药剂师开出的处方每日用量低于50MMEs，71%的药剂师开的处方用药时间低于7天。开高剂量阿片类药物的医疗机构和接受高剂量阿片类药物的患者持续存在，其中一半以上出现在邻近年份。

总之，绝大多数医疗机构开出的处方均低于推荐阈值，说明大多数美国医疗机构在开处方时很谨慎。针对这类医疗机构的干预措施不太可能产生有益变化，并可能造成不必要的负担。很大一部分医疗机构多年来与患者建立了良好关系。减少阿片类药物不当处方的干预措施应侧重于改善患者治疗、管理复杂疼痛的患者、减少合并症，而非强制实施处方阈值。

附：英文原文

Title: Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study

Author: Mathew V Kiang, Keith Humphreys, Mark R Cullen, Sanjay Basu

Issue&Volume: 2020/01/29

Abstract:

Objective To examine the distribution and patterns of opioid prescribing in the United States.

Design Retrospective, observational study.

Setting National private insurer covering all 50 US states and Washington DC.

Participants An annual average of 669?495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017.

Main outcome measures Standardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions.

Results In 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748?000 MMEs—nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years.

Conclusions Most prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.

DOI: 10.1136/bmj.l6968

Source: https://www.bmj.com/content/368/bmj.l6968