University of North Carolina at Chapel Hill School of Medicine, 231 MacNider, 229B, CB 7225, Chapel Hill, NC 27599.
J Manag Care Spec Pharm. 2014 Nov;20(11):1122-9. doi: 10.18553/jmcp.2014.20.11.1122.
The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits.
To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success.
We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability.
Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists.
Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.
处方阿片类药物的滥用已成为北卡罗来纳州（NC）的一个紧迫的健康问题，尤其是在医疗补助计划（Medicaid）患者中，他们因滥用和过量用药而导致发病率和死亡率居高不下。NC 医疗补助部（DMA）实施了一项受助人管理锁定计划，该计划限制了被认定的患者在 12 个月内只能从 1 名处方医生和 1 家药房获得苯二氮䓬类、阿片类和某些抗焦虑药物的处方，以防止药物滥用并减少医疗补助福利的过度使用。
（a）评估药剂师对 NC 受助人管理锁定计划（MLIP）实施的看法，以及（b）确定药剂师的信念和态度如何促进或阻碍其成功。
我们对为锁定患者服务的 NC 药剂师进行了 12 次结构电话访谈。通过构建分析对访谈回答进行分析，该分析确定了主题，这些主题组织成 3 个领域：组织和实施、感知效果和可接受性。
大多数受访者对该计划表示了积极的体验，但对其对处方药物滥用的影响表示怀疑。该计划成功地利用了药剂师作为管制药物守门员的角色，而且该计划的程序不需要药剂师的积极努力。然而，受访者建议 DMA 改善沟通和外展工作，以解决药剂师对该计划目的缺乏了解以及对锁定患者出现问题的补救措施感到困惑的问题。DMA 还应解决该计划可能干扰获得医疗保健和治疗的方式，允许患者在同一诊所看多个医生，并澄清那些复杂健康问题需要多个专家的患者的程序。
尽管确定了可能的改进措施，但 NC MLIP 具有很大的成功潜力，因为它利用了药剂师的药物把关作用，同时最大限度地减少了成功实施所需的努力。
