The Impact of a PDMP-EHR Data Integration Combined With Clinical Decision Support on Opioid and Benzodiazepine Prescribing Across Clinicians in a Metropolitan Area.
The Impact of a PDMP-EHR Data Integration Combined With Clinical Decision Support on Opioid and Benzodiazepine Prescribing Across Clinicians in a Metropolitan Area.
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PDMP-EHR数据集成的影响以及临床决策支持对大都市地区临床医生各个临床医生的阿片类药物和苯二氮卓类药物的影响。
DOI：
10.1097/adm.0000000000000905
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发表时间：
2022-05-01
影响因子：
5.5
通讯作者：
Blum J
中科院分区：
文献类型：
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作者：
Calcaterra SL;Butler M;Olson K;Blum J
尽管没有确凿的证据表明处方药监测计划（PAPs）可以降低阿片类药物相关的死亡率，但指南建议PAPs对阿片类药物处方进行审查。报告的一些使用障碍包括获取数据的耗时过程和工作流程中断。我们为一个医疗保健系统中的123名临床医生提供了PPDP-电子健康记录（EHR）集成程序。医疗保健系统和大都市地区的剩余临床医生没有获得PDMP-EHR集成程序访问权限。我们通过将州PMDP数据库中的处方数据与个体临床医生联系起来，确定了阿片类药物处方的变化。主要结果是科罗拉多居民在项目整合前后接受高剂量阿片类药物处方（>90毫克吗啡当量）的变化。次要结局包括长效阿片类药物治疗的变化以及阿片类药物和苯二氮卓类药物处方日的重叠。接下来，我们调查了临床医生，以评估他们在PDMP-EHR集成程序访问之前和之后对PIMPS数据采集的看法。在所有三个临床医生组中，高剂量阿片类药物的使用显著减少（PDMP-EHR整合计划访问[27.6%，至6.9%，p < 0.001];在同一医疗保健系统中没有计划访问[4.8%至2.9%，p < 0.001]，并且在大都市地区没有计划访问[13.5%至6.1%，p < 0.001]）。临床医生报告使用PDMP-EHR集成程序与州PALGORITE网站相比，PALGORITE数据的访问得到了改善（98.6%）。进一步研究PDMP-EHR集成程序对患者和临床医生的结果可能会阐明这项技术在公共卫生和临床实践中的作用。
Despite inconclusive evidence that prescription drug monitoring programs (PDMP) reduce opioid-related mortality, guidelines recommend PDMP review with opioid prescribing. Some reported barriers to use include time-consuming processes to obtain data and workflow disruptions. We provided access to a PMDP-electronic health record (EHR) integrated program to 123 clinicians in one healthcare system. Remaining clinicians within the healthcare system and metropolitan area did not receive PDMP-EHR integration program access. We identified changes in opioid prescribing by linking prescription data available in the state PMDP database to individual clinicians. The primary outcome was change in receipt of high dose opioid prescriptions (>90 milligram morphine equivalents) by Colorado residents before and after program integration. Secondary outcomes included changes in long-acting opioid receipt and overlapping opioid and benzodiazepine prescription days. Next, we surveyed clinicians to assess their perspectives on PDMP data acquisition before and after PDMP-EHR integration program access. High-dose opioid receipt decreased significantly across all three clinician groups (PDMP-EHR integration program access [27.6%, to 6.9%, p < 0.001]; no program access in the same healthcare system [4.8% to 2.9%, p < 0.001], and no program access across the metropolitan area [13.5% to 6.1%, p < 0.001]). Clinicians reported improved access to PDMP data using the PDMP-EHR integrated program compared to the state PDMP website (98.6%). Further study of PDMP-EHR integration programs on patient and clinician outcomes may illuminate the role of this technology in public health and in clinical practice.