处方药监测计划和“药丸磨坊”法对高风险阿片类药物开处方者的影响：一项比较中断时间序列分析
Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis.
作者信息
Chang Hsien-Yen, Lyapustina Tatyana, Rutkow Lainie, Daubresse Matthew, Richey Matt, Faul Mark, Stuart Elizabeth A, Alexander G Caleb
机构信息
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Baltimore, MD 21205, United States; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St. W6035, Baltimore, MD 21205, United States.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St. W6035, Baltimore, MD 21205, United States.
出版信息
Drug Alcohol Depend. 2016 Aug 1;165:1-8. doi: 10.1016/j.drugalcdep.2016.04.033. Epub 2016 Jun 2.
BACKGROUND
Prescription drug monitoring programs (PDMPs) and pill mill laws were implemented to reduce opioid-related injuries/deaths. We evaluated their effects on high-risk prescribers in Florida.
METHODS
We used IMS Health's LRx Lifelink database between July 2010 and September 2012 to identify opioid-prescribing prescribers in Florida (intervention state, N: 38,465) and Georgia (control state, N: 18,566). The pre-intervention, intervention, and post-intervention periods were: July 2010-June 2011, July 2011-September 2011, and October 2011-September 2012. High-risk prescribers were those in the top 5th percentile of opioid volume during four consecutive calendar quarters. We applied comparative interrupted time series models to evaluate policy effects on clinical practices and monthly prescribing measures for low-risk/high-risk prescribers.
RESULTS
We identified 1526 (4.0%) high-risk prescribers in Florida, accounting for 67% of total opioid volume and 40% of total opioid prescriptions. Relative to their lower-risk counterparts, they wrote sixteen times more monthly opioid prescriptions (79 vs. 5, p<0.01), and had more prescription-filling patients receiving opioids (47% vs. 19%, p<0.01). Following policy implementation, Florida's high-risk providers experienced large relative reductions in opioid patients and opioid prescriptions (-536 patients/month, 95% confidence intervals [CI] -829 to -243; -847 prescriptions/month, CI -1498 to -197), morphine equivalent dose (-0.88mg/month, CI -1.13 to -0.62), and total opioid volume (-3.88kg/month, CI -5.14 to -2.62). Low-risk providers did not experience statistically significantly relative reductions, nor did policy implementation affect the status of being high- vs. low- risk prescribers.
CONCLUSIONS
High-risk prescribers are disproportionately responsive to state policies. However, opioids-prescribing remains highly concentrated among high-risk providers.
背景
实施处方药监测计划（PDMPs）和药丸磨坊法以减少阿片类药物相关的伤害/死亡。我们评估了它们对佛罗里达州高风险处方医生的影响。
方法
我们使用艾美仕市场研究公司（IMS Health）的LRx Lifelink数据库，在2010年7月至2012年9月期间识别佛罗里达州（干预州，N = 38,465）和佐治亚州（对照州，N = 18,566）开具阿片类药物的处方医生。干预前、干预期和干预后期分别为：2010年7月至2011年6月、2011年7月至2011年9月以及2011年10月至2012年9月。高风险处方医生是在连续四个日历季度中阿片类药物用量处于前5百分位的医生。我们应用比较中断时间序列模型来评估政策对低风险/高风险处方医生临床实践和每月处方措施的影响。
结果
我们在佛罗里达州识别出1526名（4.0%）高风险处方医生，他们占阿片类药物总量的67%和阿片类药物处方总数的40%。相对于低风险的同行，他们每月开具的阿片类药物处方多16倍（79张对5张，p<0.01），且有更多接受阿片类药物处方配药的患者（47%对19%，p<0.01）。政策实施后，佛罗里达州的高风险医生的阿片类药物患者和阿片类药物处方大幅相对减少（每月-536名患者，95%置信区间[CI] -829至-243；每月-847张处方，CI -1498至-197），吗啡当量剂量（每月-0.88mg，CI -1.13至-0.62），以及阿片类药物总量（每月-3.88kg，CI -5.14至-2.62）。低风险医生没有经历统计学上显著的相对减少，政策实施也没有影响高风险与低风险处方医生的状态。
结论
高风险处方医生对州政策的反应差异很大。然而，阿片类药物的开具仍然高度集中在高风险医生中。
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