Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis
Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis
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DOI：
10.1016/j.drugalcdep.2016.04.033
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发表时间：
2016-08-01
影响因子：
4.2
通讯作者：
Alexander, G. Caleb
中科院分区：
文献类型：
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作者：
Chang, Hsien-Yen;Lyapustina, Tatyana;Alexander, G. Caleb
背景：实施处方药监测计划（PDMP）和药丸法以减少阿片类药物相关的伤害/死亡。我们评估其对高风险处方在佛罗里达。方法：我们使用IMS健康的LRx Lifelink数据库之间2010年7月和2012年9月确定阿片类药物处方处方在佛罗里达（干预状态，N：38，465）和格鲁吉亚（控制状态，N：18，566）。干预前、干预和干预后阶段分别为：2010年7月至2011年6月、2011年7月至2011年9月和2011年10月至2012年9月。高风险处方者是在连续四个日历季度中阿片类药物用量前5%的处方者。我们采用比较中断的时间序列模型来评估政策对临床实践的影响，并每月处方措施为低风险/高风险prescribers.Results的：我们确定了1526（4.0%）高风险处方在佛罗里达，占阿片类药物总量的67%，总阿片类药物处方的40%。相对于低风险患者，他们每月开阿片类药物处方的次数是低风险患者的16倍（79对5，p < 0.01），并且有更多的处方填充患者接受阿片类药物（47%对19%，p < 0.01）。在政策实施后，佛罗里达的高风险提供者经历了阿片类药物患者和阿片类药物处方的相对大幅减少（-536例患者/月，95%置信区间[CI] -829至-243;-847次处方/月，CI -1498至-197），吗啡等效剂量（-0.88 mg/月，CI -1.13至-0.62）和总阿片样物质体积（-3.88 kg/月，CI -5.14至-2.62）。低风险提供者的相对减少在统计上并不显着，政策实施也没有影响高风险与低风险处方者的地位。结论：高风险处方者对国家政策的反应不成比例。然而，类阿片处方仍然高度集中于高风险提供者。(C)2016爱思唯尔爱尔兰有限公司版权所有。
Background: Prescription drug monitoring programs (PDMPs) and pill mill laws were implemented to reduce opioid-related injuries/deaths. We evaluated their effects on high-risk prescribers in Florida.Methods: We used IMS Health's LRx Lifelink database between July 2010 and September 2012 to identify opioid-prescribing prescribers in Florida (intervention state, N: 38,465) and Georgia (control state, N: 18,566). The pre-intervention, intervention, and post-intervention periods were: July 2010-June 2011, July 2011-September 2011, and October 2011-September 2012. High-risk prescribers were those in the top 5th percentile of opioid volume during four consecutive calendar quarters. We applied comparative interrupted time series models to evaluate policy effects on clinical practices and monthly prescribing measures for low-risk/high-risk prescribers.Results: We identified 1526 (4.0%) high-risk prescribers in Florida, accounting for 67% of total opioid volume and 40% of total opioid prescriptions. Relative to their lower-risk counterparts, they wrote sixteen times more monthly opioid prescriptions (79 vs. 5, p < 0.01), and had more prescription-filling patients receiving opioids (47% vs. 19%, p < 0.01). Following policy implementation, Florida's high-risk providers experienced large relative reductions in opioid patients and opioid prescriptions (-536 patients/month, 95% confidence intervals [CI] -829 to -243; -847 prescriptions/month, CI -1498 to -197), morphine equivalent dose (-0.88 mg/month, CI -1.13 to -0.62), and total opioid volume (-3.88 kg/month, CI -5.14 to -2.62). Low-risk providers did not experience statistically significantly relative reductions, nor did policy implementation affect the status of being high- vs. low- risk prescribers.Conclusions: High-risk prescribers are disproportionately responsive to state policies. However, opioids-prescribing remains highly concentrated among high-risk providers. (C) 2016 Elsevier Ireland Ltd. All rights reserved.