The Prescriber Opioid Risk Reduction Strategies (PORRS) Study

前述阿片类药物风险降低策略(PORRS)研究 摘要 阿片类药物滥用、滥用和成瘾是日益严重的公共卫生问题。处方阿片类药物相关 过量用药从1999-2009年增加了两倍(Warner等人，2009年)，急诊科因滥用和 2004年至2009年，处方药滥用增加了一倍，其中近一半(47.9%)的入院涉及 处方类阿片(SAMSHA，2011年)。主要关注的是15岁的青少年和成年人--。 最令人担忧的阿片类药物(如羟考酮、氢可酮、美沙酮、吗啡、可待因)存在于 被归类为附表二和附表三管制物质的实体和组合药物产品。 管理这些产品及其带来的风险是各种公共和私人努力的重点。主修 公共倡议包括已得到支持的州级处方药监测计划(PDMP) 十多年来一直由美国司法部和最近的美国食品和药物管理局 (FDA)领导的风险评估和管理战略(REMS)计划，解决延期释放和 长效阿片类药物。公共和私人健康保险公司已经实施了限制阿片类药物处方的政策 并越来越多地向处方医生提供有关处方问题的实时、特定于患者的信息。 在诊所或提供者层面，研究文献支持临床实践，如简短的筛查以确定 阿片类药物滥用问题和治疗合同，以解决这些问题。 这些举措中的每一个都提供了一种策略，处方医生可以使用该策略来识别和/或降低阿片类药物风险 通过患者评估、教育或监测。但开处方的人在多大程度上知道这些 策略以及不同的处方者如何在日常实践中使用这些策略？这些在多大程度上 被认为有效的策略，处方者认为什么会增加它们的有效性？尽管 这些策略对于降低阿片类药物风险的重要性，对处方者对任何一种策略的看法知之甚少 基本上，对于处方者如何比较或同时使用它们，我们一无所知。 这项研究将解决这些问题，并根据对这些问题的答案，制定建议和 加强使用阿片类药物风险降低战略的实用工具。重点关注威斯康星州的处方者- 将对选定的全科医生和专科医生进行广泛的调查，以描述他们使用和 单独和结合对具体战略的看法(具体目标1)。调查数据将得到补充 与应答者实践模式相关的信息，然后进行分析以确定与使用相关的因素 以及对具体战略的看法(具体目标2)。在审查了这些结果和受访者的 为提高阿片类药物风险降低策略的有效性，该项目的顾问组将 制定和传播改进建议；在咨询小组的协助下，项目工作人员将 开发实用工具，协助处方人员使用具体的阿片类药物风险降低战略(具体目标3)。

The Prescriber Opioid Risk Reduction Strategies (PORRS) Study Abstract Opioid misuse, abuse and addiction are growing public health problems. Prescription opioid-related overdoses tripled from 1999-2009 (Warner et al 2009) and emergency department admissions for misuse and abuse of prescription drugs doubled from 2004-2009 with almost half (47.9%) of these admissions involving prescription opioids (SAMSHA 2011). Primary concerns focus on adolescent and adult populations aged 15-64. Opioids of greatest concern (e.g., oxycodone, hydrocodone, methadone, morphine, codeine) are found in single- entity and combination drug products categorized as Schedule II and Schedule III controlled substances. Managing these products and the risk they present is the focus of diverse public and private efforts. Major public initiatives include state-level Prescription Drug Monitoring Programs (PDMPs) that have been supported by the U.S. Department of Justice for over a decade and the more recent U.S. Food and Drug Administration (FDA)-led Risk Evaluation and Management Strategies (REMS) program that addresses extended-release and long-acting opioids. Public and private health insurers have implemented policies that limit opioid prescribing and increasingly provide prescribers with real-time, patient-specific information regarding prescribing concerns. At the clinic- or provider-level, research literature supports clinical practices such as brief screening to identify problems with opioid abuse and treatment contracts to address them. Each of these initiatives provides a strategy that prescribers can use to identify and/or reduce opioid risk through patient assessment, education, or monitoring. But to what extent do prescribers know about these strategies and how do different prescribers employ them in day-to-day practice? To what extent are these strategies viewed as effective and what do prescribers feel would increase their effectiveness? Despite the importance of these strategies for opioid risk reduction, little is known about prescriber perspectives on any one of them and essentially nothing is known about how prescribers see them comparatively or use them in tandem. This study will address these questions and, based on answers to them, develop recommendations and practical tools to enhance use of opioid risk reduction strategies. Focusing on prescribers in Wisconsin, a state- wide survey of selected generalist and specialist physicians will be conducted to describe their use of and perspectives on specific strategies, alone and in combination (Specific Aim 1). Survey data will be supplemented with information related to respondent practice patterns then analyzed to identify factors associated with use and perspectives on specific strategies (Specific Aim 2). After reviewing these results and respondents' suggestions for improving effectiveness of opioid risk reduction strategies, the project's advisory group will develop and disseminate improvement recommendations; with advisory group assistance, project staff will develop practical tools to assist prescribers with using specific opioid risk reduction strategies (Specific Aim 3).