Potentially Inappropriate Use of Transdermal Fentanyl in Working-Age and Older Adult Populations with Non-Cancer Pain: Nationwide Cross-Sectional Study
Notice bibliographique
Résumé
Background: As a potent opioid analgesic, fentanyl transdermal patches (FTDs) have been widely used in patients with moderate to severe pain. However, increasing concerns about the opioid epidemic have made it important to strengthen the rational use and management of FTDs. Objective: Our objective was to investigate the trends in the use of FTD and to evaluate potentially inappropriate FTD use in patients with noncancer pain, based on established evaluation criteria, referring various recommendations and guidelines. Methods: A nationwide cross-sectional study was conducted using a national insurance claims database from 2014 to 2020. The study included patients who were prescribed FTDs at least once a year in an outpatient setting, while excluding cancer or pediatric patients. To identify potentially inappropriate use, we developed evaluation criteria based on the established recommendations for the safe use of prescription opioids in patients with noncancer pain and assessed each patient's compliance. The working-age and older adult groups were compared to evaluate the differences in FTD use, and modified Lorenz curves and Gini coefficients were used to assess the equality of FTD use. Results: A total of 5386 patients and their 19,800 reimbursements were included in the study. The number of patients with FTDs decreased from 58.6 to 53.7 per 100,000 registrants between 2014 and 2020. Meanwhile, the number of reimbursements increased by 7.4%, from 203.2 to 218.1 per 100,000 registrants during the same period. The working-age patients had an average of 3.9 reimbursements per year, with an average morphine milligram equivalent per day (MME/day) of 64.4 for each reimbursement. The older adult patients had an average of 3.5 reimbursements per year, and their average MME/day was 47.9. As a result of applying the evaluation criteria, 567 (24.5%) working-age patients and 531 (17.3%) older adult patients were identified as potentially inappropriate FTD users. Among patients with multiple FTD prescriptions, the working-age group with potentially inappropriate FTD use had significantly higher estimated MME/day than the older adult group (P<.001). The modified Lorenz curve showed that more than 70% of the total FTDs used in the working-age group were consumed by those with potentially inappropriate FTD use, while older adult group with potentially inappropriate FTD use accounted for less than 50% of the total older adult patients. The working-age patients also had a higher Gini coefficient than the older adult group, indicating unequal use of FTDs (0.461 vs 0.406). Conclusions: Although the number of patients receiving FTD prescriptions has decreased during the study period, the total amount of FTDs consumed increased, suggesting that caution is warranted. This study also highlights the potential for inappropriate FTD use in working-age patients. Further research is needed to quantify and qualify the risk factors in patients with potentially inappropriate use, given the clinical rationale associated with prescribing FTDs.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».