Physician attitudes and experiences with Maryland's prescription drug monitoring program (PDMP)
Physician attitudes and experiences with Maryland's prescription drug monitoring program (PDMP)
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DOI：
10.1111/add.13620
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发表时间：
2017-02-01
期刊：
影响因子：
6
通讯作者：
Alexander, G. Caleb
中科院分区：
文献类型：
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作者：
Lin, Dora H.;Lucas, Eleanor;Alexander, G. Caleb
目标 医生对处方药监测计划 (PDMP) 的使用因州而异。在马里兰州医生中，我们试图 (1) 估计 PDMP 对阿片类药物处方变化的影响，(2) 大致了解 PDMP 的实用范围，以及 (3) 确定 2013 年实施后 PDMP 使用的障碍。设计横断面邮政调查，将回复与 PDMP 注册和使用的州记录联系起来，在专业和注册阶层内随机抽样医生。背景设定为美国马里兰州。参与者 总共 1000 名接受调查的初级保健、疼痛和急诊医学医生分为三个亚群：PDMP 非注册者、非用户的 PDMP 注册者和 PDMP 用户；对 916 名符合资格的医生中的 405 名受访者 (44%) 进行了分析。测量 主要结果测量是 PDMP 的使用。关键预测因素是临床特征，包括实践类型和开阿片类药物的患者数量。结果 未发现响应波偏差。 70% 的医生认为 PDMP 的使用减少了他们开阿片类药物的用量并提高了他们开阿片类药物的舒适度。四分之三 (74%) 的 PDMP 用户表示这些数据对于告知阿片类药物处方非常有用，尽管五分之一 (20%) 表示难以获取数据。通常报告的 PDMP 使用障碍是缺乏对其存在和注册过程的了解。在调整关键临床特征后的多变量分析中，在管理式医疗组织执业与较低的 PDMP 使用率相关[发生率比 (IRR) = 0.19，95% 置信区间 (CI) = 0.05-0.73]。相反，每月为 50 名以上患者开阿片类药物的医生访问 PDMP 的频率是每月为 10 名以下患者开阿片类药物的医生的三倍（IRR = 3.00，95 % CI = 1.07-8.43）。结论 在这项针对美国马里兰州医生的调查中，大多数参与者报告说，处方药监测计划 (PDMP) 通过减少处方量和提高阿片类药物处方的舒适度，改善了他们的阿片类药物处方。使用 PDMP 的常见障碍包括不了解该计划、注册困难和数据访问困难。
Aims Physicians' use of prescription drug monitoring programs (PDMPs) varies by state. Among Maryland physicians, we sought to (1) estimate the PDMP impact on changes in opioid prescribing, (2) approximate the scope of PDMP utility and (3) determine the barriers to PDMP use after its 2013 implementation. Design Cross-sectional postal survey linking responses to state records of PDMP registration and use, randomly sampling physicians within specialty and registration strata. Setting Maryland, USA. Participants A total of 1000 surveyed primary care, pain and emergency medicine physicians stratified into three subpopulations: PDMP non-registrants, PDMP registrants who were non-users and PDMP users; 405 respondents (44%) of 916 eligible physicians were analysed. Measurements Primary outcome measure was PDMP use. Key predictors were clinic characteristics, including type of practice and number of patients prescribed opioids. Findings No response-wave bias was identified. Seventy per cent of physicians believed PDMP access decreased their amount and increased their comfort level in prescribing opioids. Three-fourths (74%) of PDMP users reported the data very useful for informing opioid prescribing, although one-fifth (20%) reported difficulty accessing the data. Commonly reported barriers to PDMP use were lack of knowledge regarding its existence and registration process. In multivariable analysis after adjusting for key clinic characteristics, practicing at a managed care organization was associated with lower PDMP use [incidence rate ratio (IRR) = 0.19, 95% confidence interval (CI) = 0.05-0.73]. Conversely, physicians who prescribed opioids for more than 50 patients accessed the PDMP three times as often as those prescribing opioids for fewer than 10 patients monthly (IRR = 3.00, 95 % CI = 1.07-8.43). Conclusions In this survey of Maryland, USA physicians, most participants reported that prescription drug monitoring programs (PDMPs) improved their opioid prescribing by decreasing prescription amounts and increasing comfort with prescribing opioids. Common barriers to PDMP use included not knowing about the program, registration difficulties and data access difficulties.