Kreiner Peter W, Strickler Gail K, Undurraga Eduardo A, Torres Maria E, Nikitin Ruslan V, Rogers Anne
PDMP Center of Excellence, Schneider Institutes for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02453-2728, United States.
PDMP Center of Excellence, Schneider Institutes for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02453-2728, United States.
Drug Alcohol Depend. 2017 Apr 1;173 Suppl 1:S31-S38. doi: 10.1016/j.drugalcdep.2016.11.020.
Prescription opioids are commonly overprescribed. However, validated measures of inappropriate controlled substance prescribing are lacking. This study examined associations between prescriber risk indicators developed as part of a public health surveillance project and medical board disciplinary actions against prescribers.
We compiled 12 prescriber risk indicators using data from the Maine prescription drug monitoring program (PDMP) for 2010. We used logistic regression models to assess the relative likelihood of the top 1%, 2%, 5%, and 10% of prescribers on each risk indicator having been subject to medical board disciplinary actions, those citing inappropriate prescribing, or those involving license suspension or revocation, during 2010-2014, controlling for prescriber medical specialty and gender.
The top 1% of prescribers for number of patients, opioid prescriptions per day, and opioid dosage prescribed per day had a greater likelihood of medical board disciplinary actions citing inappropriate prescribing, relative to a matched sample of other (non-top 1%) prescribers. Of the 56 prescribers in the top 1% for opioid prescriptions per day, nine (16.1%) were sanctioned for inappropriate prescribing, compared with 11 of 224 (0.5%) in the comparison group. The top 2% of prescribers for opioid dosage per day, and average distance patients travel to prescriber, had a greater likelihood of actions involving license suspension, revocation, or denial for renewal.
Measures derived from PDMP data may be useful in assessing levels of inappropriate prescribing of controlled substances in a population of prescribers, and in evaluating changes associated with efforts to influence prescriber behavior.
处方阿片类药物普遍存在开具过量的情况。然而，目前缺乏对不适当的管制药物处方的有效衡量标准。本研究调查了作为公共卫生监测项目一部分制定的开处方者风险指标与针对开处方者的医学委员会纪律处分之间的关联。
我们利用缅因州2010年处方药监测项目（PDMP）的数据编制了12个开处方者风险指标。我们使用逻辑回归模型来评估在2010 - 2014年期间，在每个风险指标上排名前1%、2%、5%和10%的开处方者受到医学委员会纪律处分、因不适当处方被引用或涉及执照暂停或吊销的相对可能性，并对开处方者的医学专业和性别进行了控制。
与其他（非前1%）开处方者的匹配样本相比，在患者数量、每日阿片类药物处方量和每日开具的阿片类药物剂量方面排名前1%的开处方者，因不适当处方而受到医学委员会纪律处分的可能性更大。在每日阿片类药物处方量排名前1%的56名开处方者中，有9名（16.1%）因不适当处方而受到制裁，相比之下，对照组的224名中有11名（0.5%）。在每日阿片类药物剂量排名前2%的开处方者以及患者前往开处方者处就诊的平均距离方面，涉及执照暂停、吊销或拒绝续签的行动可能性更大。
从PDMP数据得出的指标可能有助于评估开处方者群体中管制药物不适当处方的水平，并评估与影响开处方者行为的努力相关的变化。
