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的复杂患者的护理。具体而言，该研究考察了全州处方监测计划（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，成瘾或转移或滥用受控物质的意图。在过去十年中，处方阿片类药物的可获得性增加导致阿片类药物滥用，中毒和相关死亡大幅增加。作为回应，38个州已经实施了PMP，试图对抗这种不断上升的流行病，但对PMP有效性的研究仍然有限。很少有研究探讨了提供者可能使用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专注于执法，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年实施一项以公共卫生为重点的PMP，提供一个独特的机会，研究提供者如何将PMP纳入临床护理，并为PMP使用的临床指南的发展提供信息。这项研究有三个具体目标。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统计特征，并找出使用PMP数据的障碍。这些发现将有助于州PMP提高供应商的采用率。其次，我们的目标是了解医疗服务提供者如何以及何时使用PMP数据来干预患者，并做出关于处方受控药物或更适当治疗的临床决策。这些发现将通过提供有关使用PMP以提高护理质量的建议，为国家临床指南的制定提供信息。第三，我们将比较PMP使用者和非使用者的患者结局，包括住院、急诊使用和转移证据。这些数据将开始探索PMP是否能有效减少受控处方药的转移和滥用，这是许多PMP的基础假设，但迄今为止，这在很大程度上尚未得到验证。实现这些目标的研究方法包括提供者的电子调查，与PMP用户的定性访谈，临床决策过程与“超级用户”的映射，以及对患者结果的索赔和药房数据的定量分析。

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.