Effects of Implementation and Enforcement Differences in Prescription Drug Monitoring Programs in 3 States: Connecticut, Kentucky, and Wisconsin.
Effects of Implementation and Enforcement Differences in Prescription Drug Monitoring Programs in 3 States: Connecticut, Kentucky, and Wisconsin.
复制标题
DOI：
10.1177/1178221821992349
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Ohlrich J
中科院分区：
文献类型：
--
作者：
Dickson-Gomez J;Christenson E;Weeks M;Galletly C;Wogen J;Spector A;McDonald M;Ohlrich J
处方药监测计划 (PDMP) 旨在通过跟踪医疗提供者开具的处方药物和药房分发的预定药物来遏制阿片类药物的滥用和转移。 PDMP 对阿片类药物处方、误用和过量率的影响参差不齐，部分原因是各州 PDMP 的可变性和衡量这种复杂性的困难，以及对 PDMP 组成部分的实施和执行缺乏关注。本研究采用对来自康涅狄格州、肯塔基州和威斯康星州这 3 个州（康涅狄格州、肯塔基州和威斯康星州）不同 PDMP 的关键知情人的定性访谈，探讨各州 PDMP 特征的差异；如何实施、监督和执行这些措施；以及这些计划的意外负面后果。我们对来自各州代表以下部门的主要知情人进行了深入访谈：PDMP 和疼痛诊所监管机构、医疗补助计划、州许可委员会、药房、急诊医学部门、疼痛管理诊所、急救人员、毒品法庭、药物治疗项目、药物辅助治疗 (MAT) 提供者和减少伤害组织。访谈指南根据参与者的角色探讨了参与者对 PDMP 的体验和看法。使用协作、持续比较的方法进行数据分析。虽然所有三个州都有强制性的注册和报告要求，但各州在这些要求的实施和执行以及对提供者处方的监控程度方面有所不同。这些反过来又影响了医疗提供者对 PDMP 的看法，并改变了提供者开阿片类药物的方式。州 PDMP 的意外后果包括处方不足，以及“抛弃”长期使用阿片类药物或患有阿片类药物使用障碍的患者，这可能是非法海洛因或阿片类药物使用增加的原因。具有类似任务授权的州 PDMP 在实施和执行方面可能存在很大差异。在确定 PDMP 对阿片类药物滥用和过量的影响时，考虑这些差异非常重要。
Prescription Drug Monitoring Programs (PDMPs) were designed to curb opioid misuse and diversion by tracking scheduled medications prescribed by medical providers and dispensed by pharmacies. The effects of PDMPs on opioid prescription, misuse and overdose rates have been mixed due in part to variability in states’ PDMPs and difficulties measuring this complexity, and a lack of attention to implementation and enforcement of PDMP components. The current study uses qualitative interviews with key informants from 3 states with different PDMPs, Connecticut, Kentucky and Wisconsin to explore differences in the characteristics of the PDMPs in each state; how they are implemented, monitored and enforced; and unintended negative consequences of these programs. We conducted in-depth interviews with key informants from each state representing the following sectors: PDMP and pain clinic regulation agencies, Medicaid programs, state licensing boards, pharmacies, emergency medicine departments, pain management clinics, first responders, drug courts, drug treatment programs, medication assisted treatment (MAT) providers, and harm reduction organizations. Interview guides explored participants’ experiences with and opinions of PDMPs according to their roles. Data analysis was conducted using a collaborative, constant comparison method. While all 3 states had mandated registration and reporting requirements, the states differed in the implementation and enforcement of these and the extent to which provider prescribing was monitored. These, in turn, influenced how medical providers perceived the PDMP and changed how providers prescribed opioids. Unintended consequences of state PDMPs included under-prescribing for pain and “dumping” patients who were long term users of opioids or who had developed opioid use disorders and may explain the increase in illicit heroin or opioid use. State PDMPs with similar mandates may differ greatly in implementation and enforcement. These differences are important to consider when determining the effects of PDMPs on opioid misuse and overdose.
登录
查看更多内容
影响因子：
6
作者：
Lin, Dora H.;Lucas, Eleanor;Alexander, G. Caleb
通讯作者：
Alexander, G. Caleb
影响因子：
4.2
作者：
Chang, Hsien-Yen;Lyapustina, Tatyana;Alexander, G. Caleb
通讯作者：
Alexander, G. Caleb
影响因子：
4.4
作者：
Ali, Mir M.;Dowd, William N.;Novak, Scott P.
通讯作者：
Novak, Scott P.
影响因子：
1.1
作者：
Barrett, Kirsten;Watson, Ashby
通讯作者：
Watson, Ashby
影响因子：
3.5
作者：
Meadowcroft, Devon;Whitacre, Brian
通讯作者：
Whitacre, Brian