Aberrant drug-related behaviors: unsystematic documentation does not identify prescription drug use disorder.
Aberrant drug-related behaviors: unsystematic documentation does not identify prescription drug use disorder.
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与药物相关的异常行为：不系统的记录无法识别处方药使用障碍。
DOI：
10.1111/j.1526-4637.2012.01497.x
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Liebschutz,JaneM
中科院分区：
文献类型：
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作者：
Meltzer,EllenC;Rybin,Dennis;Meshesha,LidiaZ;Saitz,Richard;Samet,JeffreyH;Rubens,SoniaL;Liebschutz,JaneM
目的：不存在基于证据的方法来识别初级保健 (PC) 患者处方受控药物的处方药使用障碍 (PDUD)。建议将异常药物相关行为 (ADRB) 作为替代指标。我们的目的是确定患者电子病历 (EMR) 中记录的 ADRB 是否可以作为识别 PDUD 的代理。设计。对城市学术医疗中心的 PC 患者进行横断面研究。受试者。264 名患有慢性疼痛（≥3 个月）的说英语的患者（18-60 岁），过去接受过 ≥1 种阿片类镇痛药或苯二氮卓类药物处方年，在门诊 PC 就诊期间招募。结果测量。综合国际诊断访谈定义的精神障碍诊断和统计手册，第四版 (DSM-IV) 诊断过去一年的 PDUD 且无障碍。在进入研究之前和之后的一年内，对 EMR 进行了 15 种预先指定的 ADRB（例如提前补充药物、被盗药物）的审查。 Fisher 精确检验比较了有和没有 PDUD 的参与者之间每个 ADRB 的频率。结果。61 名参与者 (23%) 符合 DSM-IV PDUD 标准，203 名 (77%) 没有疾病； 85% 记录了一项或多项 ADRB。各组之间的个体行为频率几乎没有差异，只有患有 PDUD 的参与者 (N = 10, 16%) 与无疾病的参与者 (N = 8, 4%) 相比，“表现出醉酒或喝醉”的频率更高，P = 0.002。唯一常见的 ADRB 是“因疼痛紧急就诊”，并没有区分患有和不患有疾病的患者（82% PDUD 与 78% 无疾病，P= 0.6）。结论。ADRB 的 EMR 记录在服用阿片类药物或苯二氮卓类药物的 PC 患者中很常见，但不系统的临床医生记录无法识别 PDUD。需要基于证据的方法。
Objective.No evidence-based methods exist to identify prescription drug use disorder (PDUD) in primary care (PC) patients prescribed controlled substances. Aberrant drug-related behaviors (ADRBs) are suggested as a proxy. Our objective was to determine whether ADRBs documented in electronic medical records (EMRs) of patients prescribed opioids and benzodiazepines could serve as a proxy for identifying PDUD.Design.A cross-sectional study of PC patients at an urban, academic medical center.Subjects.Two hundred sixty-four English-speaking patients (ages 18–60) with chronic pain (≥3 months), receiving ≥1 opioid analgesic or benzodiazepine prescription in the past year, were recruited during outpatient PC visits.Outcome Measures.Composite International Diagnostic Interview definedDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition(DSM-IV) diagnoses of past year PDUD and no disorder. EMRs were reviewed for 15 prespecified ADRBs (e.g., early refill, stolen medications) in the year before and after study entry. Fisher's exact test compared frequencies of each ADRB between participants with and without PDUD.Results.Sixty-one participants (23%) met DSM-IV PDUD criteria and 203 (77%) had no disorder; 85% had one or more ADRB documented. Few differences in frequencies of individual behaviors were noted between groups, with only “appearing intoxicated or high” documented more frequently among participants with PDUD (N = 10, 16%) vs no disorder (N = 8, 4%),P= 0.002. The only common ADRB, “emergency visit for pain,” did not discriminate between those with and without the disorder (82% PDUD vs 78% no disorder,P= 0.6).Conclusions.EMR documentation of ADRBs is common among PC patients prescribed opioids or benzodiazepines, but unsystematic clinician documentation does not identify PDUDs. Evidence-based approaches are needed.