Use of Prescription Monitoring Programs to Improve Patient Care and Outcomes

描述（由申请人提供）：本研究的总体目标是帮助提供者改善对要求控制处方药物的复杂患者的护理。具体而言，该研究考察了全州范围内的处方监测计划（PMP）的潜力，以帮助提供者评估特定患者是否有合法的疼痛需求，成瘾或意图转移或滥用管制物质。在过去十年中，处方类阿片可得性的增加导致了类阿片滥用、中毒和相关死亡的大幅增加。作为回应，38个州实施了预防管理方案，试图对抗这一日益严重的流行病，但对预防管理方案有效性的研究仍然有限。很少有研究检查了提供者可能使用pmp来决定是否开处方或转介更适当的护理的过程。大多数州的pmp侧重于执法，目的是识别“医生购物者”并规范不适当或非法的处方。然而，俄勒冈州计划在2010年实施PMP，以公共卫生为重点，提供一个独特的机会来研究提供者如何将PMP整合到临床护理中，并为PMP使用的临床指南的制定提供信息。这项研究有三个具体目的。首先，我们的目标是比较使用或不使用PMP的提供者的专业和人口特征，并确定使用PMP数据的障碍。这些发现将有助于各州PMPs提高供应商的采用率。其次，我们的目标是了解提供者如何以及何时使用PMP数据对患者进行干预，并就处方控制药物或参考更合适的治疗做出临床决定。这些发现将为国家临床指南的制定提供信息，为使用PMPs提高护理质量提供建议。第三，我们将比较PMP使用者和非使用者之间的患者结果，包括住院、急诊科使用和转移的证据。这些数据将开始探索pmp是否有效地减少受管制处方药的转移和滥用，这是许多pmp的假设，但迄今为止，这在很大程度上仍未经检验。实现这些目标的研究方法包括对供应商的电子调查，对PMP用户的定性访谈，对“超级用户”的临床决策过程进行映射，以及对患者结果的索赔和药房数据进行定量分析。

DESCRIPTION (provided by applicant): The overarching goal of this research is to help providers improve the care of complex patients requesting controlled prescription medication. Specifically, the study examines the potential of a statewide prescription monitoring program (PMP) to help providers assess whether a given patient has a legitimate pain need, an addiction, or intent to divert or misuse controlled substances. Over the past decade, increasing availability of prescription opioids has led to a substantial increase in opioid misuse, poisonings, and related deaths. In response, 38 states have implemented PMPs in an attempt to combat this rising epidemic, but research on PMP effectiveness remains limited. Few studies have examined the processes by which providers might use PMPs to decide whether to prescribe or to refer for more appropriate care. Most states' PMPs focus on law enforcement, with the aim of identifying "doctor shoppers" and regulating inappropriate or illegal prescribing. However, Oregon plans to implement a PMP in 2010 with a public health focus, offering a unique opportunity to study how providers integrate PMPs into clinical care and to inform the development of clinical guidelines for PMP use. This study has three specific aims. First, we aim to compare the specialty and demographic characteristics of providers who use or do not use the PMP, and to identify barriers to using PMP data. These findings will assist state PMPs to increase adoption rates among providers. Second, we aim to understand how and when providers use PMP data to intervene with patients and make clinical decisions about prescribing controlled medications or referring to more appropriate treatment. These findings will inform the development of national clinical guidelines by offering recommendations regarding use of PMPs to improve quality of care. Third, we will compare patient outcomes among PMP users and non-users, including hospitalizations, emergency department use, and evidence of diversion. These data will begin to explore whether PMPs are effective at reducing diversion and misuse of controlled prescription medications, an assumption underlying many PMPs, but which, to date, remains largely untested. The research methods to accomplish these aims include an electronic survey of providers, qualitative interviews with PMP users, mapping of clinical decision-making processes with "super users," and quantitative analysis of claims and pharmacy data on patient outcomes.