集中处方网络对阿片类镇痛药和苯二氮䓬类药物不合理处方的影响。
Effect of a centralized prescription network on inappropriate prescriptions for opioid analgesics and benzodiazepines.
机构信息
Department of Anesthesiology, University of British Columbia, Vancouver, BC, Canada.
出版信息
CMAJ. 2012 Nov 6;184(16):E852-6. doi: 10.1503/cmaj.120465. Epub 2012 Sep 4.
BACKGROUND
Opioid analgesics and benzodiazepines are often misused in clinical practice. We determined whether implementation of a centralized prescription network offering real-time access to patient-level data on filled prescriptions (PharmaNet) reduced the number of potentially inappropriate prescriptions for opioids and benzodiazepines.
METHODS
We conducted a time series analysis using prescription records between Jan. 1, 1993, and Dec. 31, 1997, for residents of the province of British Columbia who were receiving social assistance or were 65 years or older. We calculated monthly percentages of filled prescriptions for an opioid or a benzodiazepine that were deemed inappropriate (those issued by a different physician and dispensed at a different pharmacy within 7 days after a filled prescription of at least 30 tablets of the same drug).
RESULTS
Within 6 months after implementation of PharmaNet in July 1995, we observed a relative reduction in inappropriate filled prescriptions for opioids of 32.8% (95% confidence interval [CI] 31.0%-34.7%) among patients receiving social assistance; inappropriate filled prescriptions for benzodiazepines decreased by 48.6% (95% CI 43.2%-53.1%). Similar and statistically significant reductions were observed among residents 65 years or older.
INTERPRETATION
The implementation of a centralized prescription network was associated with a dramatic reduction in inappropriate filled prescriptions for opioids and benzodiazepines.
背景
阿片类镇痛药和苯二氮䓬类药物在临床实践中经常被滥用。我们旨在确定实施集中式处方网络（提供实时访问患者已填具处方的个人数据）是否能减少阿片类药物和苯二氮䓬类药物的潜在不适当处方数量。
方法
我们使用 1993 年 1 月 1 日至 1997 年 12 月 31 日不列颠哥伦比亚省居民的处方记录进行了时间序列分析，这些居民正在接受社会援助或年满 65 岁。我们计算了每月被认为不适当的阿片类或苯二氮䓬类药物的已填具处方的百分比（由不同医生开具且在同一种药物至少 30 片的已填具处方后 7 天内在不同药房配药的处方）。
结果
在 1995 年 7 月 PharmaNet 实施后的 6 个月内，我们观察到接受社会援助的患者中，不适当的阿片类药物已填具处方的相对减少了 32.8%（95%置信区间[CI]为 31.0%-34.7%）；苯二氮䓬类药物的不适当已填具处方减少了 48.6%（95% CI 为 43.2%-53.1%）。在 65 岁及以上的居民中也观察到类似且具有统计学意义的减少。
解释
集中式处方网络的实施与阿片类药物和苯二氮䓬类药物的不适当已填具处方数量的急剧减少有关。
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