How Does Use of a Prescription Monitoring Program Change Medical Practice?
How Does Use of a Prescription Monitoring Program Change Medical Practice?
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DOI：
10.1111/j.1526-4637.2012.01452.x
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发表时间：
2012-10-01
期刊：
影响因子：
3.1
通讯作者：
Friedmann, Peter D.
中科院分区：
文献类型：
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作者：
Green, Traci C.;Mann, Marita R.;Friedmann, Peter D.
目标。本研究的目的是测试康涅狄格州 (CT) 和罗德岛州 (RI) 两个州在处方监测计划 (PMP) 使用方面的差异，这两个州具有不同的 PMP 可及性；探索PMP报告在临床实践中的使用；并检查 PMP 使用与临床医生对可疑转移或医生购物（即来自多个提供者的多个处方）的反应之间的关联。设计、背景、主题。从 2011 年 3 月到 8 月，匿名调查通过电子邮件发送给获得 CT (N = 16,924) 和 RI (N = 5,567) 处方 II 类药物许可的医疗服务提供者。结果措施。 PMP 的使用、临床实践中患者报告的使用、对可疑医生购物的反应或转移。结果。收到了 1,385 名处方者的回复：998 名处方者在 CT 中，375 名处方者在 RI 中。 PMP 在可使用电子 PMP 的 CT 中使用较多（43.9% vs 16.3%，?2 = 85.2，P < 0.0001）。 PMP 患者报告用于筛查药物滥用情况（36.2% CT vs 10.0% RI，?2 = 60.9，P < 0.0001）并检测医生购物（43.9% CT vs 18.5% RI，?2 = 68.3，P < 0.0001）。调整潜在的混杂因素后，PMP 用户对可疑药物使用行为的反应更有可能引起临床反应（即，参考另一个提供者比值比，OR，1.75 [95% 置信区间，CI，1.10，2.80]；药物滥用筛查 OR 1.93 [1.39，2.68]；重新审视疼痛/治疗协议 OR 1.97 [1.45，2.67]；进行尿液筛查 OR 1.82 [1.29, 2.57]；参考药物滥用治疗 OR 1.30 [0.96, 1.75]），而不是法律干预（OR 0.45 [0.21, 0.94]）或不作为（OR 0.09 [0.01, 0.70]）。结论。处方者对电子 PMP 的使用可能会影响医疗实践，尤其是阿片类药物滥用检测，并且与可疑医生购物或转移的临床反应相关。
Objectives. The objectives of this study were to test for differences in prescription monitoring program (PMP) use between two states, Connecticut (CT) and Rhode Island (RI), with a different PMP accessibility; to explore use of PMP reports in clinical practice; and to examine associations between PMP use and clinician's responses to suspected diversion or doctor shopping (i.e., multiple prescriptions from multiple providers). Design, Setting, Subjects. From March to August 2011, anonymous surveys were emailed to providers licensed to prescribe Schedule II medications in CT (N = 16,924) and RI (N = 5,567). Outcome Measures. PMP use, use of patient reports in clinical practice, responses to suspected doctor shopping, or diversion. Results. Responses from 1,385 prescribers were received: 998 in CT and 375 in RI. PMP use was greater in CT, where an electronic PMP is available (43.9% vs 16.3%, ?2 = 85.2, P < 0.0001). PMP patient reports were used to screen for drug abuse (36.2% CT vs 10.0% RI, ?2 = 60.9, P < 0.0001) and detect doctor shopping (43.9% CT vs 18.5% RI, ?2 = 68.3, P < 0.0001). Adjusting for potential confounders, responses by PMP users to suspicious medication use behavior were more likely to entail clinical response (i.e., refer to another provider odds ratio, OR, 1.75 [95% confidence interval, CI, 1.10, 2.80]; screen for drug abuse OR 1.93 [1.39, 2.68]; revisit pain/treatment agreement OR 1.97 [1.45, 2.67]; conduct urine screen OR 1.82 [1.29, 2.57]; refer to substance abuse treatment OR 1.30 [0.96, 1.75]) rather than legal intervention (OR 0.45 [0.21, 0.94]) or inaction (OR 0.09 [0.01, 0.70]). Conclusions. Prescribers' use of an electronic PMP may influence medical practice, especially opioid abuse detection, and is associated with clinical responses to suspected doctor shopping or diversion.