English summary: TRANSDERMAL FENTANYL USE AMONG COMMUNITY-DWELLING OLDER PEOPLE
Background The use of opioids has increased rapidly in Europe and North America, and older people may be susceptible to opioid-related adverse drug events. It has been recommended that oral opioids should be considered the first line treatment when a strong opioid is required for severe pain. The objective of this study was to investigate and describe the age-, indication-, sex- and geographic-specific utilization of transdermal fentanyl among older people residing in noninstitutional settings in Finland.
Methods Reimbursement data for fentanyl, morphine, oxycodone and hydromorphone were extracted from the Finnish National Prescription Register for 2008. Age-specific population data were used to calculate the annual prevalence of opioid use for malignant and nonmalignant pain for patients aged 99 years. The annual prevalence of transdermal fentanyl use was also calculated separately for each of the 21 hospital districts in Finland.
Results Reimbursement for transdermal fentanyl was paid to 3,173 people (37%) for malignant pain and 5,369 people (63%) for nonmalignant pain. The annual prevalence of transdermal fentanyl use for nonmalignant pain was lowest among men aged 99 years (539.2 users/10,000 women). The annual prevalence of transdermal fentanyl use was >47 times higher than that of morphine for nonmalignant pain among people aged 85 to 89 years and >97 times higher than that of morphine among people aged 90 to 94 years. A greater than 4-fold variation in the annual prevalence of transdermal fentanyl use was reported among the 21 hospital districts in Finland (range 9.5-40.6/10,000 inhabitants).
Conclusions The prevalence of transdermal fentanyl use was higher than that of morphine, oxycodone or hydromorphone among people aged >=80 years residing in noninstitutional settings in Finland. The variation in use between hospital districts suggests that organizational culture may have a strong impact on prescribing practices. Our data highlight the need for further education regarding the appropriate use of opioids among older people.
Tästä asiasta tiedettiin
- Vanhusten voimakkaan kivun hoidossa suositellaan ensisijaisesti suun kautta annettavaa opioidihoitoa.
- Kotona asuvien suomalaisten fentanyylilaastarien käyttö on lähes kaksinkertaistunut vuosien 2002-2006 aikana.
- Fentanyyli on tehokkain ja selektiivisin käytössä oleva opioidi.
- FDA julkaisi vuonna 2009 tiedotteen fentanyylilaastarien turvallisesta käytöstä.
Tämä tutkimus opetti
- Fentanyylilaastarien käyttäjien osuus lisääntyy merkittävästi iän lisääntyessä.
- Fentanyylilaastarien käyttäjistä 37 % käytti lääkettä syöpäkivun hoitoon vuonna 2008.
- Sairaanhoitopiirien välillä on suuria eroja fentanyylilaastarien kulutuksessa.
- Terveydenhuollon ammattihenkilöiden on tärkeä tuntea erityisesti vanhuksiin liittyvät fentanyylilaastarien käytön erityispiirteet.
