Objectives

To compare medication use and health resource utilization between migraineurs with evidence of opioid use at emergency department visit versus no opioid use at emergency department visit, and to examine predictors of opioid use among migraineurs at emergency department visits.

Methods

This was a retrospective study using REACHnet electronic health records (December 2013 to April 2017) from Baylor Scott & White Health Plan. The index date was defined as the first migraine-related emergency department visit after ≥6 months of enrollment. Adult patients with a migraine diagnosis and ≥6 months of continuous enrollment before and after their index dates were included. Descriptive statistics and bivariate analyses were used to compare medication use and health resource utilization between opioid users and non-opioid users. Multivariable logistic regression was used to examine predictors of opioid use at emergency department visits.

Results

A total of 788 migraineurs met eligibility criteria. Over one-third (n = 283, 35.9%) received ≥1 opioid medication during their index date emergency department visit. Morphine (n = 103, 13.1%) and hydromorphone (n = 85, 10.8%) were the most frequently used opioids. Opioid users had more hospitalizations and emergency department visits during their pre-index period (both p < 0.05). Significant (p < 0.05) predictors of opioid use at emergency department visits included past migraine-related opioid use (2–4 prescriptions, Odds Ratio = 1.66; 5–9 prescriptions, Odds Ratio = 2.12; ≥10 prescriptions, Odds Ratio = 4.43), past non-migraine-related opioid use (≥10 prescriptions, Odds Ratio = 1.93), past emergency department visits (1–3 visits, Odds Ratio = 1.84), age (45–64 years, Odds Ratio = 1.45), and sleep disorder (Odds Ratio = 1.43), controlling for covariates.

Conclusion

Opioids were commonly given to migraineurs at emergency departments. Previous opioid use, health resource utilization, age, and specific comorbidities might be used to identify migraineurs with a high risk of opioid use.

中文翻译：

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急诊科偏头痛患者使用阿片类药物的模式和预测因素：回顾性数据库分析。

目标

比较急诊科就诊时有阿片类药物使用证据的偏头痛患者与急诊科就诊时未使用阿片类药物的偏头痛患者的药物使用和卫生资源利用情况，并检验偏头痛患者急诊就诊时阿片类药物使用的预测因素。

方法

这是一项回顾性研究，使用来自 Baylor Scott & White Health Plan 的 REACHnet 电子健康记录（2013 年 12 月至 2017 年 4 月）。索引日期定义为入组≥6 个月后第一次偏头痛相关急诊就诊。包括诊断为偏头痛且在其索引日期前后连续入组≥6 个月的成年患者。描述性统计和双变量分析用于比较阿片类药物使用者和非阿片类药物使用者之间的药物使用和卫生资源利用。多变量逻辑回归用于检查急诊就诊时阿片类药物使用的预测因素。

结果

共有 788 名偏头痛患者符合资格标准。超过三分之一（n = 283，35.9%）在他们的索引日期急诊科就诊期间接受了≥1 种阿片类药物治疗。吗啡 (n = 103, 13.1%) 和氢吗啡酮 (n = 85, 10.8%) 是最常用的阿片类药物。阿片类药物使用者在指标前期间住院和急诊就诊次数更多（均p  < 0.05）。显着 ( p < 0.05) 急诊就诊时阿片类药物使用的预测因素包括既往与偏头痛相关的阿片类药物使用（2-4 个处方，优势比 = 1.66；5-9 个处方，优势比 = 2.12；≥10 个处方，优势比 = 4.43），过去非偏头痛相关的阿片类药物使用（≥10 次处方，优势比 = 1.93）、既往急诊就诊（1-3 次就诊，优势比 = 1.84）、年龄（45-64 岁，优势比 = 1.45）和睡眠障碍（优势比 = 1.43），控制协变量。

结论

阿片类药物通常用于急诊科的偏头痛患者。既往阿片类药物使用、卫生资源利用、年龄和特定合并症可用于识别阿片类药物使用风险高的偏头痛患者。