What we know, and don't know, about the impact of state policy and systems-level interventions on prescription drug overdose.
What we know, and don't know, about the impact of state policy and systems-level interventions on prescription drug overdose.
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DOI：
10.1016/j.drugalcdep.2014.10.001
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发表时间：
2014-12-01
影响因子：
4.2
通讯作者：
Jones CM
中科院分区：
文献类型：
--
作者：
Haegerich TM;Paulozzi LJ;Manns BJ;Jones CM
自20世纪90年代初以来，药物过量死亡人数一直在上升，是美国伤害死亡的主要原因。处方阿片类药物过量在这一负担中占很大比例。国家政策和系统层面的干预措施有可能影响处方药滥用和过量。我们检索了文献，通过非比较性、横断面性、前后性、时间序列、队列或对照组设计或随机/非随机试验来确定国家政策或系统级干预措施的评估。合格的研究考察了干预对提供者行为、患者行为和健康结果的影响。整体研究质量较低，时间序列或实验设计数量有限。知识和处方做法比健康结果（如过量用药）更常被衡量。局限性包括缺乏基线数据和对照组、统计测试不足、样本量小、自我报告的结果和短期随访。减少不适当的处方和使用多个提供者，并关注过量反应的策略，如处方药监测计划，保险策略，疼痛临床立法，临床指南和纳洛酮分发计划，是有希望的。改善健康结果的证据，特别是来自安全储存和处置战略以及患者教育的证据不足。虽然正在进行影响处方者和患者行为的重要努力，但有关国家政策和系统级干预措施的数据有限且不一致。改善证据基础是一个迫切的需要，这样各州、监管机构和组织就可以在政策和实践方面做出明智的选择，从而改善处方和使用，同时保护患者健康。
Drug overdose deaths have been rising since the early 1990s and is the leading cause of injury death in the United States. Overdose from prescription opioids constitutes a large proportion of this burden. State policy and systems-level interventions have the potential to impact prescription drug misuse and overdose. We searched the literature to identify evaluations of state policy or systems-level interventions using non-comparative, cross-sectional, before-after, time series, cohort, or comparison group designs or randomized/non-randomized trials. Eligible studies examined intervention effects on provider behavior, patient behavior, and health outcomes. Overall study quality is low, with a limited number of time-series or experimental designs. Knowledge and prescribing practices were measured more often than health outcomes (e.g., overdoses). Limitations include lack of baseline data and comparison groups, inadequate statistical testing, small sample sizes, self-reported outcomes, and short-term follow-up. Strategies that reduce inappropriate prescribing and use of multiple providers and focus on overdose response, such as prescription drug monitoring programs, insurer strategies, pain clinic legislation, clinical guidelines, and naloxone distribution programs, are promising. Evidence of improved health outcomes, particularly from safe storage and disposal strategies and patient education, is weak. While important efforts are underway to affect prescriber and patient behavior, data on state policy and systems-level interventions are limited and inconsistent. Improving the evidence base is a critical need so states, regulatory agencies, and organizations can make informed choices about policies and practices that will improve prescribing and use, while protecting patient health.
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DOI：
10.1016/j.jpain.2008.10.008
发表时间：
2009-02
期刊：
The journal of pain
影响因子：
--
作者：
Chou R;Fanciullo GJ;Fine PG;Adler JA;Ballantyne JC;Davies P;Donovan MI;Fishbain DA;Foley KM;Fudin J;Gilson AM;Kelter A;Mauskop A;O'Connor PG;Passik SD;Pasternak GW;Portenoy RK;Rich BA;Roberts RG;Todd KH;Miaskowski C;American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
通讯作者：
American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
影响因子：
3.1
作者：
Cochella, Susan;Bateman, Kim
通讯作者：
Bateman, Kim
影响因子：
3.1
作者：
Corson, Kathryn;Doak, Melanie N.;Dobscha, Steven K.
通讯作者：
Dobscha, Steven K.
影响因子：
3.3
作者：
Brady, Joanne E.;Wunsch, Hannah;Li, Guohua
通讯作者：
Li, Guohua
影响因子：
8.8
作者：
Ashburn, Michael A.;Caplan, Robert A.;Rice, Linda Jo
通讯作者：
Rice, Linda Jo