| Autor: |
Niemann A; Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany., Schrader NF; Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany., Speckemeier C; Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany., Abels C; Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany., Blase N; Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany., Weitzel M; Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany., Neumann A; Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany., Riederer C; DAK-Gesundheit, Nagelsweg 27, 20097 Hamburg, Germany., Nadstawek J; Association of German Doctors and Psychotherapists Practicing in Pain Medicine and Palliative Care (BVSD e.V.), Katharinenstraße 8, 10711 Berlin, Germany., Straßmeir W; Association of German Doctors and Psychotherapists Practicing in Pain Medicine and Palliative Care (BVSD e.V.), Katharinenstraße 8, 10711 Berlin, Germany., Wasem J; Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany., Neusser S; Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany. |
| Abstrakt: |
In Germany, long-term opioid treatment (L-TOT) for chronic non-tumor pain (CNTP) is discussed as not being performed according to the German guideline on L-TOT for CNTP. In the present analysis, the occurrence and predictors of inappropriate care/overuse in a cohort of German insureds with L-TOT for CNTP by the presence of a contraindication with concurrent opioid analgesic (OA) therapy were investigated. We also analyzed whether prescribing physicians themselves diagnosed a contraindication. The retrospective cohort study was based on administrative claims data from a German statutory health insurance. Eight contraindication groups were defined based on the German guideline. Logistic regressions were performed in order to identify predictors for OA prescriptions despite contraindications. The possible knowledge of the prescribing physician about the contraindication was approximated by analyzing concordant unique physician identification numbers of OA prescriptions and contraindication diagnoses. A total of 113,476 individuals (75% female) with a mean age of 72 years were included. The most common documented contraindications were primary headaches (8.7%), severe mood disorders (7.7%) and pain in somatoform disorders (4.5%). The logistic regressions identified a younger age, longer history of OA therapy, opioid related psychological problems, and outpatient psychosomatic primary care as positive predictors for all contraindication groups. |
