PDF(Pubmed)
Abstract：
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.
摘要：
在德国,慢性非肿瘤疼痛(CNTP)的长期阿片类药物治疗(L-TOT)根据德国关于CNTP的L-TOT指南进行讨论。在目前的分析中，在一组接受L-TOT治疗CNTP的德国胰岛素患者中,研究了在阿片类镇痛药(OA)治疗的同时存在禁忌症的情况下,不适当治疗/过度使用的发生和预测因素.我们还分析了处方医生自己是否诊断为禁忌症。回顾性队列研究基于德国法定健康保险的行政索赔数据。根据德国指南定义了八个禁忌症组。尽管有禁忌症，但仍进行Logistic回归以确定OA处方的预测因素。通过分析OA处方和禁忌症诊断的一致唯一医师识别号，可以近似了解处方医师关于禁忌症的可能知识。包括总共113,476名个体(75%为女性),平均年龄为72岁。最常见的记录禁忌症是原发性头痛（8.7％），严重的情绪障碍（7.7％）和躯体形式障碍的疼痛（4.5％）。逻辑回归确定了一个更年轻的年龄，OA治疗的历史较长，阿片类药物相关的心理问题，和门诊心身初级保健作为所有禁忌症组的阳性预测因子。
