Impact of initiatives to reduce prescription opioid risks on medically attended injuries in people using chronic opioid therapy
| Autor: | Susan M. Shortreed, Michael Von Korff, Ryan N. Hansen, Evette J. Ludman, Karen J. Sherman, Rod L. Walker, Kathleen Saunders, Michael L. Parchman, Sascha Dublin, Manu Thakral |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Epidemiology Injury rate Drug Prescriptions 030226 pharmacology & pharmacy Care setting 03 medical and health sciences symbols.namesake 0302 clinical medicine Craniocerebral Trauma Humans Medicine Pharmacology (medical) 030212 general & internal medicine Poisson regression Practice Patterns Physicians' Aged Delivery of Health Care Integrated business.industry Incidence Health Plan Implementation Interrupted Time Series Analysis Middle Aged United States Health care delivery Analgesics Opioid Opioid Prescription opioid Relative risk Practice Guidelines as Topic Emergency medicine symbols Female Dose reduction Chronic Pain business Follow-Up Studies Program Evaluation medicine.drug |
| Zdroj: | Pharmacoepidemiology and Drug Safety. 28:90-96 |
| ISSN: | 1053-8569 |
| DOI: | 10.1002/pds.4678 |
| Popis: | PURPOSE The purpose of the study is to determine whether initiatives to improve the safety of opioid prescribing decreased injuries in people using chronic opioid therapy (COT). METHODS We conducted an interrupted time series analysis using data from Group Health (GH), an integrated health care delivery system in the United States. In 2007, GH implemented initiatives which substantially reduced daily opioid dose and increased patient monitoring. Among GH members age 18 or older receiving COT between 2006 and 2014, we compared injury rates for patients in GH's integrated group practice (IGP; exposed to the initiatives) vs patients cared for by contracted providers (not exposed). Injuries were identified using a validated algorithm. We calculated injury incidence during the baseline (preintervention) period from 2006 to 2007; the dose reduction period, 2008 to 2010; and the risk stratification and monitoring period, 2010 to 2014. Using modified Poisson regression, we estimated adjusted relative risks (RRs) representing the relative change per year in injury rates. RESULTS Among 21 853 people receiving COT in the IGP and 8260 in contracted care, there were 2679 injuries during follow-up. The baseline injury rate was 1.0% per calendar quarter in the IGP and 0.9% in contracted care. Risk reduction initiatives did not decrease injury rates: Within the IGP, the RR in the dose reduction period was 1.01 (95% CI, 0.95-1.07) and in the risk stratification and monitoring period, 0.99 (95% CI, 0.95-1.04). Injury trends did not differ between the two care settings. CONCLUSIONS Risk reduction initiatives did not decrease injuries in people using COT. |
| Databáze: | OpenAIRE |
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