颈背痛患者进入急诊科的管理途径与阿片类药物处方之间的关系。

Maggie E. Horn DPT, MPH, PhD , Corey B. Simon DPT, PhD , Hui-Jie Lee PhD , Stephanie A. Eucker MD, PhD
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引用次数: 0

摘要

目的:确定因颈部和/或背部疼痛寻求治疗的患者急诊科(ED)后管理途径与下游阿片类药物处方之间的关系。患者和方法:我们确定了2013年1月1日至2017年11月6日期间首次因颈部和/或背部疼痛寻求急诊治疗的患者。我们使用描述性统计报告了不同管理途径的人口统计学特征和阿片类药物处方,并使用根据患者人口统计学特征调整的泊松回归评估了5种不同ED后管理途径中ED访视后12个月任何阿片类药处方的相对风险。结果:在指数ED访视后的12个月内,58.0%(n=10949)的患者服用了阿片类药物,大多数患者在第一周内服用了阿片剂(平均每日吗啡毫克当量为6.8 mg(SD 9.6 mg))。吗啡毫克当量在第4周降至0.7 mg(标准差8.2 mg),在第4周到12个月之间始终低于1 mg。与ED到初级保健提供者途径相比,指数ED访视后7天至12个月内,ED到物理治疗途径的阿片类药物处方的相对风险相似,ED到住院或重复ED访视途径的相对风险更高(增加30%;相对风险(RR),1.3;95%CI,1.17-1.44)和ED转专科途径(增加19%;RR,1.19;95%CI,1.07-1.33),而在没有随访途径的ED中则更低(减少41%;RR,0.59;95%CI,0.54-0.65)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain

Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain

Objective

To determine associations between post-emergency department (ED) management pathways and downstream opioid prescriptions in patients seeking care for incident neck and/or back pain.

Patients and Methods

We identified patients seeking first-time ED care for neck and/or back pain from January 1, 2013, through November 6, 2017. We reported demographic characteristics and opioid prescriptions across management pathways using descriptive statistics and assessed the relative risk of any opioid prescription 12 months post-ED visit among 5 different post-ED management pathways using Poisson regression adjusted for patient demographic characteristics.

Results

Within 12 months after the index ED visit, 58.0% (n=10,949) were prescribed an opioid, with most patients prescribed an opioid within the first week (average daily morphine milligram equivalents of 6.8 mg (SD 9.6 mg). The morphine milligram equivalents decreased to 0.7 mg (SD 8.2 mg) by week 4 and remained consistently less than 1 mg between week 4 and 12 months. Compared with the ED to primary care provider pathway, the relative risk of opioid prescription between 7 days and 12 months after the index ED visit was similar for the ED to physical therapy pathway, higher for both the ED to hospital admission or repeat ED visit pathway (30% increase; relative risk (RR), 1.3; 95% CI, 1.17-1.44) and the ED to specialist pathway (19% increase; RR, 1.19; 95% CI, 1.07-1.33), and lower in the ED with no follow-up visits pathway (41% decrease; RR, 0.59; 95% CI, 0.54-0.65).

Conclusion

In general, more conservative care was associated with lower opioid prescription rates, and escalated care was associated with higher opioid prescription rates.

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来源期刊
Mayo Clinic proceedings. Innovations, quality & outcomes
Mayo Clinic proceedings. Innovations, quality & outcomes Surgery, Critical Care and Intensive Care Medicine, Public Health and Health Policy
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