Pradel Vincent, Frauger Elisabeth, Thirion Xavier, Ronfle Eléonore, Lapierre Véronique, Masut Alain, Coudert Christine, Blin Olivier, Micallef Joëlle
Public Health Department, Center for Evaluation and Information on Pharmacodependence (CEIP), School of Medicine, Marseille, France.
Pharmacoepidemiol Drug Saf. 2009 Jan;18(1):36-43. doi: 10.1002/pds.1681.
Doctor-shopping (simultaneous use of several physicians by a patient) is one of the most frequent ways of diversion for prescription drugs. A specific method was used to assess the evolution of doctor-shopping for High Dosage Buprenorphine (HDB) in a French region from 2000 to 2005 and the impact of a prescription monitoring program for HDB implemented in 2004.
Data from eight periods (semesters of years 2000, 2002, 2004, and 2005) were extracted from a prescription database. Three quantities (the delivered, the prescribed, and the doctor-shopping quantity) were computed for each patient. The total doctor-shopping quantity and the doctor-shopping ratio (percentage of buprenorphine obtained through doctor-shopping) were used to evaluate the diversion of HDB among the population. The total prescribed quantity and the number of patients treated regularly were used as indicators of the access to treatment.
The doctor-shopping ratio increased from 1st semester 2000 to 1st semester 2004 (from 14.9 to 21.7%) and then decreased to 16.9% in 2nd semester 2005. The total doctor-shopping quantity followed the same evolution. The number of patients treated remained stable from 1st semester 2000 to 2nd semester 2005. The prescribed quantity increased from 1st semester 2000 to 2nd semester 2002, decreased in 1st semester 2004 (4163 g) and then remained stable.
After a four-year increase of the diversion through doctor-shopping for buprenorphine the beginning of the prescription monitoring program was concomitant with a marked decrease of doctor-shopping indicators without notable impact on the access to treatment.
“医生周旋”（患者同时就诊于多位医生）是处方药转移的最常见方式之一。采用一种特定方法评估了2000年至2005年法国某地区高剂量丁丙诺啡（HDB）的“医生周旋”情况演变，以及2004年实施的HDB处方监测项目的影响。
从处方数据库中提取了八个时间段（2000年、2002年、2004年和2005年的各学期）的数据。为每位患者计算了三个数量（发放量、处方量和“医生周旋”量）。总“医生周旋”量和“医生周旋”比例（通过“医生周旋”获得的丁丙诺啡百分比）用于评估人群中HDB的转移情况。总处方量和接受常规治疗的患者数量用作治疗可及性指标。
“医生周旋”比例从2000年第一学期到2004年第一学期有所上升（从14.9%升至21.7%），然后在2005年第二学期降至16.9%。总“医生周旋”量呈现相同的演变趋势。从2000年第一学期到2005年第二学期，接受治疗的患者数量保持稳定。处方量从2000年第一学期到2002年第二学期增加，在2004年第一学期减少（4163克），然后保持稳定。
在丁丙诺啡“医生周旋”转移情况持续四年上升之后，处方监测项目的启动伴随着“医生周旋”指标的显著下降，且对治疗可及性没有显著影响。
