EFFECTIVENESS OF PRESCRIPTION MONITORING PROGRAM USE IN EMERGENCY DEPARTMENTS

描述(申请人提供)：这项提案的最终目标是减少与处方阿片类药物相关的过量和死亡。美国国会、国家药物滥用研究所和疾病控制和预防中心已将处方阿片类药物滥用确定为首要的公共卫生问题。2008年报告的与处方阿片类药物过量有关的死亡人数为14,800人，自1999年以来增加了五倍，远远超过可卡因和海洛因造成的过量死亡人数。急诊科(ED)是39%的受控药物处方的来源，是医生购物和药物转移的特别高风险场所。促成因素包括紧急护理的间歇性和时间压力性质，缺乏长期的医患关系，以及直到最近还缺乏关于先前受控物质使用的综合数据系统。处方监测程序(PMP)是全州范围的药房数据库，旨在通过提供受控药物分配的数据来限制药物滥用。尽管PMP的费用相当高，但关于其对减少阿片类药物相关危害的影响的数据有限。PMP有效性和评估的一个主要挑战是医生采用率低；只有不到6%的合格提供者将在运营的第一年注册PMP访问。华盛顿州最近要求急诊科提供者在2012年7月之前注册PMP访问；所有87家符合条件的医院都满足了这一要求。尽管该策略不要求使用PMP，但它确实在高风险环境中创建了通用提供商PMP访问。我们利用这个机会来研究一个关键的公共卫生问题：PMP在急诊科的使用是否减少了阿片类药物的处方、过量和死亡？我们将与华盛顿州卫生保健管理局和华盛顿州处方监测计划合作，创建一个独特的数据集，将提供者PMP的使用、阿片类药物处方和结果联系起来，以实现以下目标：特定目标1.确定急诊科提供者使用PMP的预测因素2.评估急诊科PMP使用对总的、不适当的和适当的阿片类药物处方的影响3.评估急诊科PMP使用对患者结果的影响。为了实现这些目标，我们将创建一个独特的数据集，其中包含2400个提供者和140万急诊访问，将提供者PMP使用与患者索赔和死亡率文件联系起来。我们的建议将产生与政策相关的新知识，以解决处方阿片类药物滥用的公共卫生流行病。

DESCRIPTION (provided by applicant): The ultimate goal of this proposal is to reduce prescription opioid related overdoses and deaths. The U.S. Congress, the National Institute on Drug Abuse, and the Centers for Disease Control and Prevention have identified prescription opioid abuse as a top public health problem. The 14,800 prescription opioid-related overdose deaths reported in 2008 have increased five-fold since 1999 and far surpass overdose deaths from cocaine and heroin. Emergency departments (ED) are the source of 39% of prescriptions for controlled substances and represent particularly high risk settings for doctor shopping and drug diversion. Contributing factors include the episodic and time-pressured nature of emergency care, lack of a long-term physician- patient relationship, and until recently, the absence of integrated data systems about prior controlled substance use. Prescription monitoring programs (PMPs) are statewide pharmacy databases designed to limit drug misuse by providing data on controlled medication dispensing. Despite the considerable expense of PMPs, the data on their impact to reduce opioid related harms are limited. A major challenge to the effectiveness and evaluation of PMPs is low rates of physician adoption; less than 6% of eligible providers will register for PMP access in the first year of operation. Washington State recently mandated that ED providers register for PMP access by July 2012; all 87 eligible hospitals have met this requirement. Although the policy does not require PMP use, it does create universal provider PMP access in a high risk setting. We capitalize on this opportunity to study a critical public health question: Does PMP use in emergency departments reduce opioid prescribing, overdoses, and deaths? In collaboration with the Washington State Health Care Authority and the Washington State Prescription Monitoring Program, we will create a unique dataset linking provider PMP use, opioid prescribing, and outcomes to accomplish the following Aims: Specific Aim 1. Identify predictors of PMP use by emergency department providers Specific Aim 2. Assess the impact of emergency department PMP use on total, inappropriate, and appropriate opioid prescribing Specific Aim 3. Assess the impact of emergency department PMP use on patient outcomes. To achieve these Aims, we will create a unique dataset of 2,400 providers and 1.4 million ED visits that links provider PMP use to patient claims and mortality files. Our proposal will result in novel and policy-relevant knowledge to address the public health epidemic of prescription opioid abuse.