JAMA:阿片类药片监管的背景下,急诊科的疼痛处方怎么开?

2021-06-15 MedSci原创 MedSci原创

也许政策的制定需要更多的站在医生和患者的角度,而不是宏观监管。

镰状细胞病(SCD)或伴有骨转移的癌症患者经常到急诊科(ED)治疗剧烈疼痛,阿片类镇痛药仍然是ED或出院后急性疼痛的一线治疗药物。而处方药注册授权或使用处方药监测计划(PDMP)可能会无意中限制这些患者获得阿片类药物(旨在提高阿片类药物处方安全性的政策)。

有研究者调查了PDMP指令实施后这些患者的阿片类药物获得率变化之间的关联,该研究成果发表在JAMA最新期刊上。

研究者使用了2011-2017年医疗成本研究所(HCCI)的索赔数据,覆盖了2017年美国27%的个人商业保险。研究样本包括年龄在18岁到64岁之间的患者,他们在一个季度中至少有1例SCD或癌症伴骨转移,至少有1例ED遭遇(未入院)。

研究结果包括ED后阿片类药物配给的可能性,以及所配给阿片类药物的吗啡毫克当量(MMEs)。PDMP授权分为综合性(要求所有临床情况下的所有处方药使用PDMP)或非综合性(注册或使用授权不全面),立法状态和生效日期根据原始法律研究确定。

研究样本包括6239例SCD患者的18345次ED和14389例骨转移癌患者的26427次ED。分别有15.0%和14.1%的SCD患者和有骨转移的癌症患者接受了阿片类药物治疗。SCD组和骨转移癌组的平均MMEs分别为570.3和916.5。与未经授权相比,综合性PDMP授权与向SCD患者分配阿片类药物的概率从15.8%降低到11.5%相关,在伴有骨转移的癌症患者中,从14.8%降低到11.4%。综合治疗与平均MMEs从688.3降低到366.5相关,但对于伴有骨转移的癌症患者,MMEs没有变化。

根据处方药物监测项目的规定,急诊后发放的吗啡毫克等量阿片类药物

全面的PDMP指令与SCD患者或ED后骨转移的癌症患者服用阿片类药物的显著减少相关。潜在的解释包括:由于临床医生对滥用或转移的担忧而减少了处方,增加了行政负担,以及处方医生对与阿片类药物处方相关的责任的认识。研究的局限性包括缺乏关于阿片类药物是否具有临床适应症以及处方是否由ED或非ED临床医生开具的数据。未来的研究应该考虑阿片类药物的处方政策是否限制了严重急性疼痛患者的适当使用和获得治疗的机会。

参考文献:Zhang H, Kilaru AS, Meisel ZF, Bao Y. Prescription Drug Monitoring Program Mandates and Opioids Dispensed Following Emergency Department Encounters for Patients With Sickle Cell Disease or Cancer With Bone Metastasis. JAMA. Published online June 14, 2021. doi:10.1001/jama.2021.10161

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    2021-06-18 answer.col

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    2021-06-17 lhlxtx
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    2021-06-17 wwzzly
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    2021-06-15 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

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