基于课程的干预措施对医生开阿片类药物的影响和医疗监管的影响。
Effect of a course-based intervention and effect of medical regulation on physicians' opioid prescribing.
机构信息
Department of Family and Community Medicine, University of Toronto (U of T), Ontario, Canada.
出版信息
Can Fam Physician. 2013 May;59(5):e231-9.
OBJECTIVE
To examine the effects of an intensive 2-day course on physicians' prescribing of opioids.
DESIGN
Population-based retrospective observational study.
SETTING
College of Physicians and Surgeons of Ontario (CPSO) in Toronto.
PARTICIPANTS
Ontario physicians who took the course between April 1, 2000, and May 30, 2008.
INTERVENTION
A 2-day opioid-prescribing course with a maximum of 12 physician participants. Educational methods included didactic presentations, case discussions, and standardized patients. A detailed syllabus and office materials were provided.
MAIN OUTCOME MEASURES
Participants were matched with control physicians using specific variables. The primary outcome was the rate of opioid prescribing, expressed as milligrams of morphine equivalent per quarter.
RESULTS
One hundred thirty-eight course participants (120 family physicians, 15 specialists, and 3 physicians whose status was uncertain) were eligible for analysis. Of these, 68.1% were self-referred and 31.9% were referred by the CPSO. Overall, among physicians referred by the CPSO, the rate of opioid prescribing decreased dramatically in the year before course participation compared with matched control physicians. The course had no added effect on the rate of physicians' opioid prescribing in the subsequent 2 years. There was no statistically significant effect on the rate of opioid prescribing observed among the self-referred physicians. Among 15 of the self-referred physicians who, owing to the high quantities of opioids they prescribed, were not matched with control physicians, the rate of opioid prescribing decreased by 43.9% in the year following course completion.
CONCLUSION
Physicians markedly reduced the quantities of opioids they prescribed after medical regulators referred them to an opioid-prescribing course. The course itself did not lead to significant additional reductions; however, a subgroup of physicians who prescribed high quantities of opioids might have responded to what was taught in the course.
目的
考察为期两天的强化课程对医生开具阿片类药物处方的影响。
设计
基于人群的回顾性观察研究。
地点
多伦多的安大略省医师学院（CPSO）。
参与者
2000 年 4 月 1 日至 2008 年 5 月 30 日期间参加该课程的安大略省医生。
干预措施
为期两天的阿片类药物处方课程，最多可有 12 名医生参加。教育方法包括专题演讲、案例讨论和标准化患者。提供详细的教学大纲和办公材料。
主要观察指标
使用特定变量将参与者与对照医生进行匹配。主要结局指标为阿片类药物处方率，以每季度吗啡当量毫克数表示。
结果
共有 138 名课程参与者（120 名家庭医生、15 名专科医生和 3 名身份不明的医生）符合分析条件。其中，68.1%为自我推荐，31.9%由 CPSO 推荐。总体而言，在 CPSO 推荐的医生中，与匹配的对照医生相比，在参加课程前一年，阿片类药物处方率显著下降。在随后的 2 年中，该课程对医生开具阿片类药物处方的速度没有额外的影响。在自我推荐的医生中，阿片类药物处方率没有观察到统计学上的显著影响。在 15 名自我推荐的医生中，由于他们开具的阿片类药物数量较高，未与对照医生匹配，在课程完成后的一年中，阿片类药物处方率下降了 43.9%。
结论
医疗监管机构将医生转介到阿片类药物处方课程后，他们显著减少了开具的阿片类药物数量。该课程本身并没有导致显著的额外减少；然而，处方大量阿片类药物的医生亚组可能对课程中所教授的内容做出了反应。
Zotero 插件