Pearson Sallie-Anne, Soumerai Stephen, Mah Connie, Zhang Fang, Simoni-Wastila Linda, Salzman Carl, Cosler Leon E, Fanning Thomas, Gallagher Peter, Ross-Degnan Dennis
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
Arch Intern Med. 2006 Mar 13;166(5):572-9. doi: 10.1001/archinte.166.5.572.
We examined the effects of a prescription-monitoring program on benzodiazepine access among Medicaid enrollees living in neighborhoods of different racial composition.
We used interrupted time series and logistic regression to analyze data from noninstitutionalized persons aged 18 years or older (N = 124 867) enrolled continuously in New York Medicaid 12 months before and 24 months and 7 years after initiation of the program. We used census data to identify the racial composition of the neighborhoods. Outcome measures were nonproblematic use (short term, within dosing guidelines), potentially problematic use (>120 days' use or more than twice the recommended dose), and pharmacy hopping (filling prescriptions for the same benzodiazepine in different pharmacies within 7 days).
There was a sudden, sustained reduction in benzodiazepine use in all the neighborhoods after the program's introduction. Despite the lowest rates of baseline use, enrollees in predominantly (> or = 75%) black neighborhoods experienced the highest rates of discontinuation after introduction of the program. This difference remained 7 years after policy initiation. Compared with white participants, black participants were more likely to discontinue nonproblematic (odds ratio, 1.78; 95% confidence interval, 1.47-2.17) and potentially problematic (odds ratio, 1.77; 95% confidence interval, 1.45-2.17) benzodiazepine use, after adjusting for sex, eligibility status, neighborhood poverty, and baseline use. The program almost completely eliminated pharmacy hopping in all racial groups, although less among white participants (82.6%) vs black participants (88.7%).
A systematic benzodiazepine prescription-monitoring program reduced inappropriate prescribing, with a stronger effect in predominantly black neighborhoods despite lower baseline use. The policy may have resulted in an unintended decrease in nonproblematic use that disproportionately affects black populations.
我们研究了一项处方监测计划对居住在不同种族构成社区的医疗补助计划参保者获取苯二氮䓬类药物的影响。
我们采用中断时间序列分析和逻辑回归分析，数据来自18岁及以上非机构化人员（N = 124867），这些人员在该计划启动前12个月、启动后24个月和7年连续参加纽约医疗补助计划。我们使用人口普查数据确定社区的种族构成。结局指标包括无问题使用（短期，在给药指南范围内）、潜在问题使用（使用超过120天或超过推荐剂量两倍以上）以及药店换药（在7天内在不同药店为同一种苯二氮䓬类药物配药）。
该计划实施后，所有社区的苯二氮䓬类药物使用均出现突然且持续的减少。尽管基线使用率最低，但在主要为（≥75%）黑人的社区中，参保者在该计划实施后停药率最高。政策实施7年后，这种差异依然存在。在调整了性别、资格状态、社区贫困程度和基线使用情况后，与白人参与者相比，黑人参与者更有可能停止无问题（优势比，1.78；95%置信区间，1.47 - 2.17）和潜在问题（优势比，1.77；95%置信区间，1.45 - 2.17）的苯二氮䓬类药物使用。该计划几乎完全消除了所有种族群体中的药店换药现象，尽管白人参与者（82.6%）的消除比例低于黑人参与者（88.7%）。
一项系统性的苯二氮䓬类药物处方监测计划减少了不适当的处方开具，尽管基线使用量较低，但在主要为黑人的社区中效果更强。该政策可能导致无问题使用量意外减少，且对黑人人群的影响尤为严重。
