目的:退伍军人健康管理局(VHA)实施了阿片类药物风险缓解分层工具(STORM),以降低阿片类药物镇痛药患者严重不良事件(SAE)的风险。VHA机构被授权对STORM确定为高风险的患者进行病例审查。这项研究的目的是测量这项任务对新诊断为阿片类药物使用障碍(OUD)的VHA患者的全因死亡率和SAE的影响。
方法:在所有140个VHA设施中进行的阶梯式分组随机对照试验的二次分析,以设施为随机化单位,从2018年到2020年。设置和参与者美国VHA设施被随机分配到病例审查的前1%或5%的高风险患者处方阿片类镇痛药由STORM确定。在试验期间,有28,251名患者被诊断为OUD,并且根据他们接受OUD诊断的设施的状态被认为是控制或治疗。对诊断前90天内至少有一种阿片类镇痛药处方的患者进行了事后分析。然后在诊断后90天接受处方进行分层,以评估结果对阿片类药物停药的敏感性.
方法:全因死亡率和阿片类药物相关,与毒品有关,与自杀有关,和其他SAE在OUD诊断后90天内。
结果:强制病例审查增加了90天死亡率的几率(优势比[OR]1.74,95%置信区间[CI]1.06,2.87),但没有显着改变SAE的几率。在OUD诊断之前但之后未接受阿片类药物处方的患者中,相对于对照组患者,90天内全因死亡的几率为5.87(95%CI1.85,18.58).
结论:退伍军人健康管理局新诊断为阿片类药物使用障碍的患者在扩大高危患者处方阿片类药物的病例审查授权后,全因死亡率增加。
The Veterans Health Administration (VHA) implemented the Stratification Tool for Opioid Risk Mitigation (STORM) to reduce the risk of serious adverse events (SAE) among patients with opioid analgesic prescriptions. VHA facilities were mandated to
case review patients identified as high risk by STORM. The aim of this study was to measure the effect of this mandate on all-cause mortality and SAEs among VHA patients newly diagnosed with opioid use disorder (OUD).
Secondary analysis of a stepped-wedged cluster randomized controlled trial conducted at all 140 VHA facilities, with facility as the unit of randomization, from 2018 to 2020.
United States VHA facilities were randomized to
case review the top 1 or 5% of high-risk patients prescribed opioid analgesics identified by STORM. A total of 28 251 patients were diagnosed with OUD during the trial and were considered control or treatment depending on the status of the facility where they received their OUD diagnosis. Post-hoc analyses among patients who had at least one opioid analgesic prescription in the 90 days prior to diagnosis were conducted and were then stratified by receipt of a prescription in the 90 days following diagnosis to assess the sensitivity of results to opioid discontinuation.
All-cause mortality and opioid-related, drug-related, suicide-related and other SAEs within 90 days of OUD diagnosis.
Mandated
case review increased the odds of 90-day mortality [odds ratio (OR) = 1.74, 95% confidence interval (CI) = 1.06, 2.87], but did not significantly change the odds of SAEs. Among patients who received an opioid prescription prior to but not after OUD diagnosis, the odds of all-cause mortality within 90 days was 5.87 (95% CI = 1.85, 18.58) relative to control patients.
Veterans Health Administration patients newly diagnosed with opioid use disorder experienced increased all-cause mortality following expansion of a
case review mandate for high-risk patients prescribed opioids.