政策要点工人补偿机构已经制定了阿片类药物审查政策,以减少不安全的处方。提供者报告的处方比过去更加有限和谨慎;患者和提供者都报告了协作疼痛管理关系和患者满意的疼痛控制。尽管制药公司和患者倡导者表达了恐惧,阿片类药物审查计划通常不会导致患者疼痛失控或功能下降,来自患者或提供者的愤怒或抵抗,或损害患者-提供者关系或临床自主权。其他拥有广泛医生网络的保险提供商可能希望考虑类似的质量改进工作,以支持安全的阿片类药物处方。
背景:不安全的处方做法一直是阿片类药物接受不当的主要原因之一,不安全使用,在美国用药过量。华盛顿和俄亥俄州的工人补偿机构已经实施了阿片类药物审查计划(ORP)-一种基于利用率审查的质量改进形式-以遏制不安全的处方。有证据表明,这些法规确实减少了不安全的处方,但是制药公司和患者倡导者对也可能产生的负面影响表示担忧。这项研究探讨了三组核心问题是否实际上已经过去:(1)患者的疼痛未得到控制或功能降低,(2)对患者或提供者的ORP的愤怒或抵抗,(3)损害患者-提供者关系或临床自主权。
方法:对48名患者进行了深入的半结构化访谈(来自华盛顿,27名来自俄亥俄州)和32名提供商(18名来自华盛顿,来自俄亥俄州的14人),他们被故意采样以代表一系列伤害和练习类型。主题编码是使用归纳和演绎方法开发的码本进行的。
结果:阿片类药物法规的后果总体上是积极的:提供者报告了更有限的处方和对多模式疼痛控制的关注;患者报告了令人满意的疼痛控制和恢复以及与提供者的合作关系。参与者将这些模式归因于阿片类药物谨慎的广泛环境;他们通常不认为工人的补偿政策具有明显的影响力。患者和提供者都经常评论与工人补偿机构互动的困难方面;这些影响范围从简单的不便到延迟护理,无法控制的疼痛,身体恢复的可能性降低。
结论:一般来说,对于患者或提供者来说,三种类型的担忧负面影响都没有实现。尽管与工人赔偿机构的互动涉及与其他保险公司互动的典型困难,阿片类药物控制似乎通常具有积极作用,并且通常被认为是有利的。
Policy Points Workers\' compensation agencies have instituted opioid
review policies to reduce unsafe prescribing. Providers reported more limited and cautious prescribing than in the past; both patients and providers reported collaborative pain-management relationships and satisfactory pain control for patients. Despite the fears articulated by pharmaceutical companies and patient advocates, opioid
review programs have not generally resulted in unmanaged pain or reduced function in patients, anger or resistance from patients or providers, or damage to patient-provider relationships or clinical autonomy. Other insurance providers with broad physician networks may want to consider similar quality-improvement efforts to support safe opioid prescribing.
BACKGROUND: Unsafe prescribing practices have been among the central causes of improper reception of opioids, unsafe use, and overdose in the United States. Workers\' compensation agencies in Washington and Ohio have implemented opioid
review programs (ORPs)-a form of quality improvement based on utilization
review-to curb unsafe prescribing. Evidence suggests that such regulations indeed reduce unsafe prescribing, but pharmaceutical companies and patient advocates have raised concerns about negative impacts that could also result. This study explores whether three core sets of problems have actually come to pass: (1) unmanaged pain or reduced function among patients, (2) anger or resistance to ORPs from patients or providers, and (3) damage to patient-provider relationships or clinical autonomy.
METHODS: In-depth semistructured interviews were conducted with 48 patients (21 from Washington, 27 from Ohio) and 32 providers (18 from Washington, 14 from Ohio) who were purposively sampled to represent a range of injury and practice types. Thematic coding was conducted with codebooks developed using both inductive and deductive approaches.
RESULTS: The consequences of opioid regulations have been generally positive: providers report more limited prescribing and a focus on multimodal pain control; patients report satisfactory pain control and recovery alongside collaborative relationships with providers. Participants attribute these patterns to a broad environment of opioid caution; they do not generally perceive workers\' compensation policies as distinctly impactful. Both patients and providers comment frequently on the difficult aspects of interacting with workers\' compensation agencies; effects of these range from simple inconvenience to delays in care, unmanaged pain, and reduced potential for physical recovery.
CONCLUSIONS: In general, the three types of feared negative impacts have not come to pass for either patients or providers. Although interacting with workers\' compensation agencies involves difficulties typical of interacting with other insurers, opioid controls seem to have generally positive effects and are generally perceived of favorably.