了解加巴喷丁长期使用量的增加:全国养老院临床医生处方意向调查》。

IF 2.6 3区 医学 Q3 GERIATRICS & GERONTOLOGY
Clinical Gerontologist Pub Date : 2024-10-01 Epub Date: 2024-07-17 DOI:10.1080/07317115.2024.2379974
Jonathan D Winter, J William Kerns, Danya M Qato, Katherine M Winter, Nicole Brandt, Linda Wastila, Christopher Winter, Alex H Krist, Sarah R Reves, Rebecca S Etz
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引用次数: 0

摘要

目的探索长期使用加巴喷丁的适应症,并阐明促使疗养院(NHs)加巴喷丁处方迅速增加的因素:方法:使用 SurveyMonkey 对养老院处方者进行全国性横断面匿名调查。通过与 NH 临床医生组织合作,以众包的方式获得方便的样本。调查由一个多学科团队开发,调查内容参考了试点数据/现有文献:共完成 131 份调查问卷。参与者:71%为白人,52%为女性,71%为医生。标签外加巴喷丁处方无处不在。几乎每位临床医生都将加巴喷丁用于治疗神经病理性疼痛,大多数医生将其用于治疗任何形式的疼痛。许多临床医生还处方加巴喷丁来缓解精神症状和行为。临床医生的处方受到阿片类药物、抗精神病药物和抗焦虑药物减量政策的影响,因为人们认为加巴喷丁是一种不受监控且更安全的替代药物:标签外加巴喷丁用量的增加与减少阿片类药物的努力密切相关,因为越来越多的新罕布什尔州临床医生使用加巴喷丁作为不受监控的阿片类药物替代品。然而,我们的研究结果突显了因精神症状而长期开具处方的重要性并未得到充分认识,而减少精神药物的举措也起到了类似的作用,这一现象值得进一步研究:临床医生认为加巴喷丁比其替代药物更安全。临床意义:临床医生认为加巴喷丁比其替代药物更安全,但事实是否如此尚不清楚;加巴喷丁使用量增加对个人和人群造成的风险在很大程度上尚属未知。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Understanding Long-Stay Gabapentin Use Increases: A National Nursing Home Clinician Survey on Prescribing Intent.

Objectives: Explore the indications for long-stay gabapentin use and elucidate the factors spurring the rapid increase in gabapentin prescribing in nursing homes (NHs).

Methods: National cross-sectional survey of NH prescribers distributed anonymously using SurveyMonkey. Sampling for convenience was obtained through crowdsourcing, leveraging collaborations with NH clinician organizations. Developed by a multidisciplinary team, pilot data/existing literature informed survey content.

Results: A total of 131 surveys completed. Participants: 71% white, 52% female, 71% physicians. Off-label gabapentin prescribing was ubiquitous. Nearly every clinician used gabapentin for neuropathic pain, most for any form of pain. Many clinicians also prescribe gabapentin to moderate psychiatric symptoms and behaviors. Clinicians' prescribing was influenced by opioid, antipsychotic, and anxiolytic reduction policies because gabapentin was perceived as an unmonitored and safer alternative.

Conclusions: Off-label gabapentin increases are closely linked to opioid reduction efforts as more NH clinicians utilize gabapentin as an unmonitored opioid alternative. Our results highlight, however, the less recognized significance of long-stay prescribing for psychiatric symptoms and the similar contribution of psychotropic reduction initiatives, a phenomenon warranting further scrutiny.

Clinical implications: Clinicians perceive gabapentin as safer than the drugs it is replacing. Whether this is true remains unclear; the individual- and population-level risks of increased gabapentin use are largely unknown.

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来源期刊
Clinical Gerontologist
Clinical Gerontologist GERIATRICS & GERONTOLOGY-PSYCHIATRY
CiteScore
6.20
自引率
25.00%
发文量
90
审稿时长
>12 weeks
期刊介绍: Clinical Gerontologist presents original research, reviews, and clinical comments relevant to the needs of behavioral health professionals and all practitioners who work with older adults. Published in cooperation with Psychologists in Long Term Care, the journal is designed for psychologists, physicians, nurses, social workers, counselors (family, pastoral, and vocational), and other health professionals who address behavioral health concerns found in later life, including: -adjustments to changing roles- issues related to diversity and aging- family caregiving- spirituality- cognitive and psychosocial assessment- depression, anxiety, and PTSD- Alzheimer’s disease and other neurocognitive disorders- long term care- behavioral medicine in aging- rehabilitation and education for older adults. Each issue provides insightful articles on current topics. Submissions are peer reviewed by content experts and selected for both scholarship and relevance to the practitioner to ensure that the articles are among the best in the field. Authors report original research and conceptual reviews. A unique column in Clinical Gerontologist is “Clinical Comments." This section features brief observations and specific suggestions from practitioners which avoid elaborate research designs or long reference lists. This section is a unique opportunity for you to learn about the valuable clinical work of your peers in a short, concise format.
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