Information on doctor and pharmacy shopping for opioids adds little to the identification of presumptive opioid abuse disorders in health insurance claims data

IF 5.1 Q1 SUBSTANCE ABUSE
A. Walker, L. Weatherby, M. Cepeda, Daniel C Bradford
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引用次数: 3

Abstract

Background Doctor and pharmacy shopping (“Shopping”) for opioids is related to opioid abuse and is associated with opioid overdose and death. Lacking identifiers for prescribers and pharmacies, many data resources (notably the US FDA’s Sentinel System) cannot evaluate Shopping. We used data in which presumptive Shopping could be identified. We investigated whether US health insurance claims data could perform as well as Shopping to identify people with evidence for opioid abuse. Methods In this cross-sectional study, we examined health insurance claims from 164,923 persons with at least two dispensing of opioids in 18 months, the first occurring in 2012. Evidence for the presence of a possible opioid abuse disorder was drawn from predictive patterns of drug fills, diagnoses and care-seeking identified in a companion research project, and Shopping was determined using a published index. The prevalence of presumptive opioid abuse was examined across levels of Shopping. The comparison between Shopping and insurance-claims-derived covariates in the detection of apparent opioid abuse was examined in multiple regression analyses. Results Despite a strong correlation between presumptive opioid abuse and Shopping, most persons with extensive Shopping did not manifest presumptive opioid abuse, and half of the population with presumptive opioid abuse did not exhibit Shopping. As Shopping ranged from “None” to “Extensive,” the prevalence of presumptive opioid abuse increased from 0.28 to 5.0 per 100. The discriminating power of Shopping for identifying opioid abuse could be replaced using insurance claims data. Conclusion The results suggest that patient characteristics that can be inferred from insurance claims data provide as complete discrimination of persons with presumptive opioid abuse as does a full assessment of doctor and pharmacy shopping. The inference rests on patterns of health services and drug dispensing that are indicative of doctor–pharmacy shopping and of opioid abuse. There was no direct evaluation of patients. The extent to which the conclusions are generalizable beyond the study population – Americans with health insurance coverage in the early part of this decade – is uncertain in a quantitative sense. The qualitative conclusion is that diagnostic data in health insurance databases can be predictive of behaviors consistent with opioid abuse and that more elaborate indices such as doctor and pharmacy shopping may add little. Registration: ClinicalTrials.gov study number: NCT02668549.
关于医生和药房购买阿片类药物的信息对确定健康保险索赔数据中假定的阿片类药物滥用障碍几乎没有帮助
医生和药房购买阿片类药物与阿片类药物滥用有关,并与阿片类药物过量和死亡有关。由于缺乏处方者和药店的标识符,许多数据资源(特别是美国FDA的哨兵系统)无法评估购物。我们使用了可以识别推定购物的数据。我们调查了美国健康保险索赔数据是否可以像购物一样识别有阿片类药物滥用证据的人。方法在这项横断面研究中,我们检查了来自164,923名在18个月内至少两次配发阿片类药物的人的健康保险索赔,第一次发生在2012年。可能存在阿片类药物滥用障碍的证据来自一个同伴研究项目中确定的药物填充、诊断和求医的预测模式,购物是使用已发表的指数确定的。推定阿片类药物滥用的流行程度在购物水平上进行了检查。购物和保险索赔衍生的协变量在检测明显的阿片类药物滥用之间的比较在多元回归分析中进行了检验。结果:尽管推定阿片类药物滥用与购物之间存在很强的相关性,但大多数广泛购物的人并未表现出推定阿片类药物滥用,而推定阿片类药物滥用的人口中有一半没有表现出购物。由于购物范围从“无”到“广泛”,推定阿片类药物滥用的患病率从每100人0.28人增加到5.0人。购物识别阿片类药物滥用的辨别能力可以用保险索赔数据取代。结论:从保险索赔数据中推断出的患者特征与对医生和药房购物的全面评估一样,可以完全区分推定的阿片类药物滥用者。这一推论基于表明医生-药房购物和阿片类药物滥用的卫生服务和药物分配模式。没有对患者进行直接评估。这些结论在多大程度上可以推广到研究人群之外——本世纪初拥有医疗保险的美国人——在数量上是不确定的。定性结论是,医疗保险数据库中的诊断数据可以预测与阿片类药物滥用一致的行为,而更详细的指标,如医生和药房购物,可能没有什么帮助。注册:ClinicalTrials.gov研究编号:NCT02668549。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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