Objective To examine the association between prescriber workforce exit, long term opioid treatment discontinuation, and clinical outcomes. Design Quasi-experimental difference-in-differences study Setting 20% sample of US Medicare beneficiaries, 2011-18. Participants People receiving long term opioid treatment whose prescriber stopped providing office based patient care or exited the workforce, as in the case of retirement or death (n=48 079), and people whose prescriber did not exit the workforce (n=48 079). Main outcomes Discontinuation from long term opioid treatment, drug overdose, mental health crises, admissions to hospital or emergency department visits, and death. Long term opioid treatment was defined as at least 60 days of opioids per quarter for four consecutive quarters, attributed to the plurality opioid prescriber. A difference-in-differences analysis was used to compare individuals who received long term opioid treatment and who had a prescriber leave the workforce to propensity-matched patients on long term opioid treatment who did not lose a prescriber, before and after prescriber exit. Results Discontinuation of long term opioid treatment increased from 132 to 229 per 10 000 patients who had prescriber exit from the quarter before to the quarter after exit, compared with 97 to 100 for patients who had a continuation of prescriber (adjusted difference 1.22 percentage points, 95% confidence interval 1.02 to 1.42). In the first quarter after provider exit, when discontinuation rates were highest, a transient but significant elevation was noted between the two groups of patients in suicide attempts (adjusted difference 0.05 percentage points (95% confidence interval 0.01 to 0.09)), opioid or alcohol withdrawal (0.14 (0.01 to 0.27)), and admissions to hospital or emergency department visits (0.04 visits (0.01 to 0.06)). These differences receded after one to two quarters. No significant change in rates of overdose was noted. Across all four quarters after prescriber exit, an increase was reported in the rate of mental health crises (0.39 percentage points (95% confidence interval 0.08 to 0.69)) and opioid or alcohol withdrawal (0.31 (0.014 to 0.58)), but no change was seen for drug overdose (−0.12 (−0.41 to 0.18)). Conclusions The loss of a prescriber was associated with increased occurrences of discontinuation of long term opioid treatment and transient increases in adverse outcomes, such as suicide attempts, but not other outcomes, such as overdoses. Long term opioid treatment discontinuation may be associated with a temporary period of adverse health impacts after accounting for unobserved confounding. No additional data available.

中文翻译：

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由于处方人员退出而停止长期阿片类药物治疗后的临床和医疗保健使用结果：准实验双重差分研究


目的 研究处方医生队伍退出、长期阿片类药物治疗停止与临床结果之间的关联。设计准实验双重差分研究 设置 20% 的美国医疗保险受益人样本，2011-18 年。参与者 接受长期阿片类药物治疗的人，其处方者停止提供基于办公室的患者护理或退出劳动力队伍，如退休或死亡的情况 (n=48 079)，以及其处方者未退出劳动力队伍的人 (n=48 079) 。主要结局 停止长期阿片类药物治疗、药物过量、精神健康危机、入院或急诊室就诊以及死亡。长期阿片类药物治疗被定义为连续四个季度每季度至少使用 60 天阿片类药物，归因于多个阿片类药物处方者。采用双重差分分析对接受长期阿片类药物治疗且处方者离开劳动力队伍的个体与接受长期阿片类药物治疗且未失去处方者的倾向匹配患者在处方者退出之前和之后进行比较。结果 从前一个季度到退出后的季度，长期阿片类药物治疗停止的患者从每 10 000 名处方者退出的患者中 132 人增加到 229 人，而继续服用处方者的患者中，这一比例为 97 人到 100 人（调整后的差异为 1.22 个百分点， 95% 置信区间 1.02 至 1.42）。在服务提供商退出后的第一季度，当停药率最高时，两组患者的自杀企图（调整后的差异 0.05 个百分点（95% 置信区间 0.01 至 0.09））、阿片类药物或酒精之间出现短暂但显着的升高提款（0.14（0.01 至 0.27))，以及入院或急诊科就诊（0.04 次就诊（0.01 至 0.06））。一到两个季度后，这些差异就消失了。没有发现药物过量发生率有显着变化。在处方者退出后的所有四个季度中，心理健康危机发生率（0.39 个百分点（95% 置信区间 0.08 至 0.69））和阿片类药物或酒精戒断率（0.31（0.014 至 0.58））均有所增加，但没有变化观察到药物过量（-0.12（-0.41 至 0.18））。结论 失去处方者与长期阿片类药物治疗中断的发生率增加以及自杀未遂等不良后果的短暂增加有关，但与服药过量等其他后果无关。考虑到未观察到的混杂因素后，长期停止阿片类药物治疗可能与暂时的不良健康影响有关。没有其他可用数据。