Effectiveness of Mandatory Prescription Drug Monitoring

强制处方药监测的有效性

基本信息

批准号：
8223182
负责人：
GUOHUA LI
金额：
$ 19万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-04-01 至 2014-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8223182
关键词：
Accident and Emergency department Accidental Injury Accounting Adoption Alprazolam Automation Benzodiazepines Cause of Death Centers for Disease Control and Prevention (U.S.)Cessation of life Characteristics Clonazepam Code Consumption Data Data Files Demographic Factors Diazepam Drug Formulations Drug Monitoring Drug Prescriptions Drug abuse Effectiveness Elements Epidemic Epidemiologic Studies Federal Government Grant Hydrocodone Individual Information Systems International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10)Intervention Law Enforcement Light Lorazepam Measures Modeling Morbidity - disease rate Non-Prescription Drugs Opioid Analgesics Outcome Measure Overdose Oxycodone Patient Education Pattern Pharmaceutical Preparations Pharmacologic Substance Physicians Poisoning Policies Prevention program Reporting Research Research Design Research Personnel Risk Sales Schedule Series Socioeconomic Factors System Testing Time United States United States National Center for Health Statistics Visit attributable mortality design disorder prevention effective intervention intervention program mortality multilevel analysis nonmedical use prescription drug abuse prevent programs public health relevance response socioeconomics substance abuse prevention

项目摘要

DESCRIPTION (provided by applicant): The broad, long term objective of the proposed project is to develop effective intervention programs for controlling the epidemic of unintentional prescription drug overdoses in the United States. The specific aims are: (1) to assess the effectiveness of state Prescription Drug Monitoring Programs (PDMPs) in reducing the sales and consumption of prescription drugs; (2) to assess the effectiveness of state PDMPs in reducing unintentional fatalities from prescription drug overdoses; and (3) to examine the association between state PDMPs and the likelihood that a poisoning death is due to unintentional prescription drug overdose. With a marked increase in the sales and consumption of Schedule II pharmaceuticals, the annual numbers of emergency department visits and unintentional deaths related to prescription drug overdoses in the United States have more than doubled since 1999. Claiming over 22,000 lives each year, prescription drug overdose has become the second leading cause of unintentional injury mortality. Previous studies have revealed that the majority of unintentional overdose morbidity and mortality are attributable to nonmedical use of opioid analgesics and benzodiazepines obtained from diversion and 'doctor shopping.' Prevention programs concentrated on physician and patient education have been inadequate to control the ongoing epidemic of prescription drug overdoses. The U.S. federal government in 2002 started the Harold Rogers grant program to support the creation and improvement of state PDMPs. As of January 2010, 34 states have established operational PDMPs, and the Centers for Disease Control and Prevention has recently called for the nationwide adoption of PDMPs. Although PDMPs represent a major policy intervention on the diversion and abuse of prescription drugs, their effectiveness in decreasing illegal transactions and detrimental consequences of prescription drug abuse has not been rigorously evaluated. The proposed project aims to test three hypotheses: (1) PDMP implementation is associated with significantly decreased sales and consumption of prescription drugs; (2) PDMP implementation is associated with significantly decreased mortality from unintentional prescription drug overdoses; and (3) PDMP implementation is associated with a significantly decreased likelihood that a poisoning death is due to unintentional prescription drug overdose. These hypotheses will be tested using quarterly data for the years 1999- 2008 from the Automation of Reports and Consolidated Orders System and the multi-cause-of-death data files, and the linear mixed effects model and multilevel individual response model with adjustment for demographic and socioeconomic factors and serial autocorrelation. Findings from the proposed research can provide much-needed empirical evidence for policy reform and improvement to control the epidemic of prescription drug overdoses. PUBLIC HEALTH RELEVANCE: Morbidity and mortality from unintentional drug overdose in the United States have more than doubled since 1999, mainly due to nonmedical use of opioid analgesics and benzodiazepines obtained through drug diversion and 'doctor shopping.' Physician and patient education programs have been inadequate to control the epidemic of prescription drug overdoses. The proposed project aims to evaluate the effectiveness of state Prescription Drug Monitoring Programs in reducing the sales and consumption of controlled substances and deaths from unintentional overdose of prescription drugs, and to provide scientific evidence for policy interventions on the ongoing epidemic.

描述（由申请人提供）：拟议项目的广泛长期目标是制定有效的干预计划，以控制美国的无意处方药过量的流行。具体目的是：（1）评估国家处方药监测计划（PDMP）在减少处方药的销售和消费方面的有效性；（2）评估国家PDMP在减少处方药过量死亡的无意死亡方面的有效性；（3）检查状态PDMP与中毒死亡的可能性是由于无意的处方药过量引起的。随着附表II制药的销售和消费的显着增加，急诊室就诊和与处方药过量服药相关的无意死亡人数自1999年以来增加了一倍以上。每年有22,000多人的生命，处方药过量的服用已成为无意识伤害死亡的第二个主要原因。先前的研究表明，大多数无意的过量发病率和死亡率都是归因于从转移和“医生购物”获得的阿片类镇痛药和苯二氮卓类药物的非医学使用。专注于医师和患者教育的预防计划不足以控制处方药过量的持续流行。 2002年，美国联邦政府启动了Harold Rogers赠款计划，以支持国家PDMP的创建和改善。截至2010年1月，已有34个州建立了PDMP，疾病控制与预防中心最近呼吁全国范围内采用PDMP。尽管PDMP代表了对处方药的转移和滥用的主要政策干预措施，但尚未对处方药滥用的非法交易和有害后果进行有效性。拟议的项目旨在检验三个假设：（1）PDMP实施与处方药的销售和消费量显着下降；（2）PDMP实施与无意处方药过量的死亡率显着降低有关；（3）PDMP的实施与中毒死亡的可能性显着降低有关，这是由于无意的处方药过量引起的。这些假设将使用1999年至2008年的季度数据进行测试，从报告和合并订单系统的自动化以及多因素的死亡数据文件，以及线性混合效应模型和多级个体响应模型，并调整了人口统计学和社会经济因素和串行自相关的调整。拟议研究的结果可以为政策改革和改进提供急需的经验证据，以控制处方药过量的流行。公共卫生相关性：自1999年以来，美国无意药过量的发病率和死亡率增加了一倍以上，这主要是由于非医学使用阿片类镇痛药和通过药物转移和“医生购物”获得的苯二氮卓类药物的使用。医师和患者教育计划不足以控制处方药过量的流行。拟议的项目旨在评估国家处方药监测计划在减少无意服用药物过量的受控物质和死亡的销售和消费方面的有效性，并为正在进行的流行病的政策干预提供科学证据。