Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims

作者：Atala Bihari Jena, Dana P. Goldman, Lauren Weaver, Pinar Karaca‐Mandic · 发表于：BMJ · 年份：2014 · DOI：10.1136/bmj.g1393 · 被引用次数：153 · 研究领域：Opioid Use Disorder Treatment、Pharmaceutical Practices and Patient Outcomes、Medication Adherence and Compliance

OBJECTIVES: To estimate the frequency and characteristics of opioid prescribing by multiple providers in Medicare and the association with hospital admissions related to opioid use. DESIGN: Retrospective cohort study. SETTING: Database of prescription drugs and medical claims in 20% random sample of Medicare beneficiaries in 2010. PARTICIPANTS: 1,808,355 Medicare beneficiaries who filled at least one prescription for an opioid from a pharmacy in 2010. MAIN OUTCOME MEASURES: Proportion of beneficiaries who filled opioid prescriptions from multiple providers; proportion of these prescriptions that were concurrently supplied; adjusted rates of hospital admissions related to opioid use associated with multiple provider prescribing. RESULTS: Among 1,208,100 beneficiaries with an opioid prescription, 418,530 (34.6%) filled prescriptions from two providers, 171,420 (14.2%) from three providers, and 143,344 (11.9%) from four or more providers. Among beneficiaries with four or more opioid providers, 110,671 (77.2%) received concurrent opioid prescriptions from multiple providers, and the dominant provider prescribed less than half of the mean total prescriptions per beneficiary (7.9/15.2 prescriptions). Multiple provider prescribing was highest among beneficiaries who were also prescribed stimulants, non-narcotic analgesics, and central nervous system, neuromuscular, and antineoplastic drugs. Hospital admissions related to opioid use increased with multiple provider prescribing: the a...