Secondary effects of an opioid-focused academic detailing program on non-opioid controlled substance prescribing in primary care.
Secondary effects of an opioid-focused academic detailing program on non-opioid controlled substance prescribing in primary care.
复制标题
以阿片类药物为重点的学术详细计划对初级保健中非阿片类药物管制药物处方的次要影响。
DOI：
10.1080/08897077.2021.1900989
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发表时间：
2021
期刊：
影响因子：
3.5
通讯作者：
Lee,ToddA
中科院分区：
文献类型：
--
作者：
Saffore,ChristopherD;Pickard,ASimon;Crawford,StephanieY;Fischer,MichaelA;Sharp,LisaK;Pointer,Sarah;Lee,ToddA
背景教育推广计划，重点是安全的阿片类药物处方和国家处方监测计划的认识可能会改变临床医生的处方行为。本研究的目的是评估阿片类药物为重点的学术详细（AD）计划对非阿片类药物控制的物质处方在primary care.MethodsA准实验前后研究的初级保健临床医生暴露和未暴露于AD程序进行了使用数据从伊利诺伊州处方监测计划从2017年12月至2019年2月。结局为临床医生平均每月开具的苯二氮卓类（BZD）、非BZD镇静催眠药和卡立普多处方。一个差异中的差异（DID）的方法，利用重复测量混合效应线性回归模型被用来比较结果的变化6个月之前和之后的program.ResultsMean每月BZD处方下降，在两组临床医生（AD暴露dn = 151; controlsn= 399）后，实施AD计划。虽然AD项目后两组的平均每月BZD处方数量均减少，但AD项目后AD暴露组的BZD处方下降速度较慢（DID = 0.73; 95% CI：0.14，1.31）。AD暴露组的平均每月卡立普多处方率比AD计划后的对照组低0.06（95% CI：-0.11，-0.01）。有没有变化，平均每月非BZD镇静催眠药处方之间的速率between the two groups.ConclusionsThe较高的相对率BZD处方在AD暴露组相比，对照组以下的AD程序可能是反映了一个意想不到的后果阿片类药物为重点的AD程序作为临床医生学会谨慎的阿片类药物处方。我们的研究结果可能表明，需要将适当的BZD处方的有针对性的教育纳入阿片类药物为重点的AD计划作为一个特色组成部分。在大规模实施以阿片类药物为重点的教育外展计划之前，这些发现值得进一步考虑和调查。
BackgroundEducational outreach programs that focus on safe opioid prescribing and awareness of state prescription monitoring programs may modify clinicians’ prescribing behavior. The objective of this study was to evaluate the secondary effects of an opioid-focused academic detailing (AD) program on non-opioid controlled substance prescribing in primary care.MethodsA quasi-experimental pre-post study of primary care clinicians exposed and unexposed to the AD program was conducted using data from the Illinois Prescription Monitoring Program from December 2017 to February 2019. Outcomes were mean monthly prescriptions for benzodiazepines (BZD), non-BZD sedative-hypnotics, and carisoprodol, per clinician. A difference-in-differences (DID) approach utilizing repeated-measures mixed-effects linear regression models was used to compare changes in outcomes six-months before and after the program.ResultsMean monthly BZD prescriptions declined in both groups of clinicians (AD-exposedn= 151; controlsn= 399) after implementation of the AD program. Although the mean monthly number of BZD prescriptions decreased in both groups after the AD program, BZD prescribing in the AD-exposed group declined at a slower rate following the AD program (DID = 0.73; 95% CI: 0.14, 1.31). The AD-exposed group had a 0.06 (95% CI: −0.11, −0.01) lower rate of mean monthly carisoprodol prescriptions compared to the control group following the AD program. There was no change in the rate of mean monthly non-BZD sedative-hypnotic prescriptions between the two groups.ConclusionsThe higher relative rate of BZD prescribing in the AD-exposed group compared to the control group following the AD program may be reflective of an unintended consequence of opioid-focused AD programs as clinicians learn to be cautious about opioid prescribing. Our findings may suggest the need for incorporation of targeted education on appropriate BZD prescribing into opioid-focused AD programs as a featured component. These findings warrant further consideration and investigation before large-scale implementation of opioid-focused educational outreach programs.