Association of the Use of a Mandatory Prescription Drug Monitoring Program With Prescribing Practices for Patients Undergoing Elective Surgery
Association of the Use of a Mandatory Prescription Drug Monitoring Program With Prescribing Practices for Patients Undergoing Elective Surgery
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DOI：
10.1001/jamasurg.2018.2666
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发表时间：
2018-12-01
期刊：
影响因子：
16.9
通讯作者：
Barth, Richard J., Jr.
中科院分区：
文献类型：
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作者：
Stucke, Ryland S.;Kelly, Julia L.;Barth, Richard J., Jr.
重要性大多数州已经采用了处方药监测计划（PAPK）的常规使用，以遏制阿片类药物的过度处方。美国外科医生学会推广使用这些项目作为“遏制阿片类药物流行的指导原则”。“然而，有一个缺乏的数据，对使用这些程序的影响，为外科病人population. ObjectiveTo确定强制使用的POMP与阿片类药物处方的做法，为接受普通外科手术的患者的关联。在新罕布什尔州的一家学术医院进行了一项前瞻性观察性队列研究，共有1057名患者接受了代表性的择期手术。从2016年7月1日至2017年6月30日，新的州立法规定，从2017年1月1日开始，在新罕布什尔州接受门诊阿片类药物处方的所有患者都必须使用阿片类药物和阿片类药物风险评估工具。修改了电子医疗处方系统，以促进和支持遵守新的要求。主要结果和措施2017年1月1日后阿片类药物处方实践的变化，以及完成POMP要求的时间。（569名妇女[53.8%]和488名男子[46.2%];平均[SD]年龄，56.8 [15.4]岁），手术后开阿片类药物的患者比例没有显著下降，（新要求前429/536 [80.0%] vs要求后401/521 [77.0%]; P = 0.29）。在强制性Pestival要求之前的6个月内，处方阿片类药物的平均数量从30.8片减少到24.0片（22.1%）;在立法后的6个月内，减少率实际上更低（从22.8片减少到21.9片[3.9%]）。这些新的要求没有确定任何高风险患者随后没有被处方阿片类药物。查询和阿片类药物滥用风险计算器一起采取了中位数时间为7分钟（范围，2-17分钟），以completed.CONCLUSIONS和RELEVANCE强制性POMP查询要求是没有显着相关的阿片类药物处方的整体率或处方药的平均数量为接受一般外科手术的患者。在任何情况下，都没有发现高风险患者，从而避免了阿片类药物处方。在某些情况下，Pestrin可以是一种有用的辅助手段，但这项研究发现，它在接受择期手术的人群中没有预期的效果。强制使用Pesticide的立法工作应针对可以证明其益处的人群。
IMPORTANCE Most states have adopted the routine use of a prescription drug monitoring program (PDMP) to curb overprescribing of opioids. The American College of Surgeons promotes the use of these programs as a "guiding principle to curb the opioid epidemic." However, there is a paucity of data on the effects of the use of these programs for surgical patient populations.OBJECTIVE To determine the association of the mandatory use of a POMP with the opioid prescribing practices for patients undergoing general surgery.DESIGN, SETTING, AND PARTICIPANTS A prospective observational cohort study was conducted at an academic hospital in New Hampshire among 1057 patients undergoing representative elective general surgical procedures from July 1, 2016, to June 30, 2017.EXPOSURES New state legislation mandated the use of a PDMP and opioid risk-assessment tool for all patients receiving an outpatient opioid prescription in New Hampshire beginning January 1, 2017. The electronic medical prescribing system was modified to facilitate and support compliance with the new requirements.MAIN OUTCOMES AND MEASURES Change in opioid prescribing practices after January 1, 2017, and time to complete POMP requirements.RESULTS Among the 1057 patients (569 women [53.8%] and 488 men [46.2%]; mean [SD] age, 56.8 [15.4] years), the percentage of patients prescribed opioids after surgery did not decrease significantly (429 of 536 [80.0%] before the new requirements vs 401 of 521 [77.0%] after the requirements; P = .29). The mean number of opioid pills prescribed decreased from 30.8 to 24.0 (22.1%) in the 6 months prior to the mandatory PDMP requirement; the rate of decrease was actually less (from 22.8 to 21.9 pills [3.9%]) in the 6 months after the legislation. These new requirements did not identify any high-risk patients who subsequently were not prescribed opioids. The query and opioid abuse risk calculator together took a median time of 7 minutes (range, 2-17 minutes) to complete.CONCLUSIONS AND RELEVANCE A mandatory POMP query requirement was not significantly associated with the overall rate of opioid prescribing or the mean number of pills prescribed for patients undergoing general surgical procedures. In no cases was a high-risk patient identified, leading to avoidance of an opioid prescription. A PDMP can be a useful adjunct in certain settings, but this study found that it did not have the intended effect in a population undergoing elective surgical procedures. Legislative efforts to mandate PDMP use should be targeted to populations in which benefit can be demonstrated.