Department of General Internal Medicine, Rhode Island Hospital, Providence, RI 02903, USA.
Pain Med. 2012 Oct;13(10):1314-23. doi: 10.1111/j.1526-4637.2012.01452.x. Epub 2012 Jul 30.
The objectives of this study were to test for differences in prescription monitoring program (PMP) use between two states, Connecticut (CT) and Rhode Island (RI), with a different PMP accessibility; to explore use of PMP reports in clinical practice; and to examine associations between PMP use and clinician's responses to suspected diversion or "doctor shopping" (i.e., multiple prescriptions from multiple providers).
DESIGN, SETTING, SUBJECTS: From March to August 2011, anonymous surveys were emailed to providers licensed to prescribe Schedule II medications in CT (N = 16,924) and RI (N = 5,567).
PMP use, use of patient reports in clinical practice, responses to suspected doctor shopping, or diversion.
Responses from 1,385 prescribers were received: 998 in CT and 375 in RI. PMP use was greater in CT, where an electronic PMP is available (43.9% vs 16.3%, χ(2) = 85.2, P < 0.0001). PMP patient reports were used to screen for drug abuse (36.2% CT vs 10.0% RI, χ(2) = 60.9, P < 0.0001) and detect doctor shopping (43.9% CT vs 18.5% RI, χ(2) = 68.3, P < 0.0001). Adjusting for potential confounders, responses by PMP users to suspicious medication use behavior were more likely to entail clinical response (i.e., refer to another provider odds ratio, OR, 1.75 [95% confidence interval, CI, 1.10, 2.80]; screen for drug abuse OR 1.93 [1.39, 2.68]; revisit pain/treatment agreement OR 1.97 [1.45, 2.67]; conduct urine screen OR 1.82 [1.29, 2.57]; refer to substance abuse treatment OR 1.30 [0.96, 1.75]) rather than legal intervention (OR 0.45 [0.21, 0.94]) or inaction (OR 0.09 [0.01, 0.70]).
Prescribers' use of an electronic PMP may influence medical practice, especially opioid abuse detection, and is associated with clinical responses to suspected doctor shopping or diversion.
本研究旨在测试两个州（康涅狄格州和罗得岛州）之间处方监控计划（PMP）使用情况的差异，这两个州的 PMP 可及性不同；探索 PMP 报告在临床实践中的使用情况；并检验 PMP 使用与临床医生对疑似滥用或“医生购物”（即从多个提供者处开多张处方）的反应之间的关联。
设计、地点、对象：2011 年 3 月至 8 月，向康涅狄格州（N=16924）和罗得岛州（N=5567）有处方镇静类药物资格的医生发送匿名调查电子邮件。
收到 1385 名处方医生的回复：康涅狄格州 998 名，罗得岛州 375 名。康涅狄格州的 PMP 使用更多，那里提供电子 PMP（43.9% vs 16.3%，χ(2)=85.2，P<0.0001）。PMP 患者报告用于筛查药物滥用（36.2% CT 与 10.0% RI，χ(2)=60.9，P<0.0001）和检测医生购物（43.9% CT 与 18.5% RI，χ(2)=68.3，P<0.0001）。在调整潜在混杂因素后，PMP 用户对可疑药物使用行为的反应更有可能涉及临床反应（即转介给其他提供者比值比，OR，1.75 [95%置信区间，CI，1.10，2.80]；筛查药物滥用 OR，1.93 [1.39，2.68]；重新评估疼痛/治疗协议 OR，1.97 [1.45，2.67]；进行尿液筛查 OR，1.82 [1.29，2.57]；转介至药物滥用治疗 OR，1.30 [0.96，1.75]），而不是法律干预（OR，0.45 [0.21，0.94]）或不采取行动（OR，0.09 [0.01，0.70]）。
临床医生使用电子 PMP 可能会影响医疗实践，特别是阿片类药物滥用的检测，并与疑似医生购物或滥用的临床反应相关。
