Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Epidemiology, University of Iowa, Iowa City, Iowa.
Pain Med. 2019 Feb 1;20(2):290-300. doi: 10.1093/pm/pny029.
To evaluate the impact of Iowa's prescription monitoring program (PMP), implemented in 2009, on opioid pain reliever (OPR) prescribing patterns.
We conducted interrupted time series analyses using 2003-2014 health insurance claims from a private health insurer in Iowa. OPR prescriptions for all beneficiaries were included. Another data set included only OPR prescription for new opioid users required to have six months of insurance coverage. We evaluate four OPR prescribing patterns: 1) average daily dosage in morphine milligrams equivalents (MME), 2) MME per prescription, 3) average days' supply per prescription, and 4) prescription rate per 1,000 insured person-years. We examined confounding and effect measure modification of the relationship between PMP and prescribing patterns by age and sex.
During the 12 years of follow-up, 1,512,388 insured Iowans contributed 6,169,634.92 person-years of follow-up. Of these, 505,274 patients filled 2,401,818 OPR prescriptions and 360,688 new OPR users filled as many first OPR prescriptions. The increasing trend of OPR prescription rates from 2003 to 2009 declined post-PMP. Similarly, there was a large decline in MME per day and MME per prescription. The OPR days' supply kept increasing post-PMP implementation, albeit at a slightly slower rate than pre-PMP implementation. There was no confounding by age and sex; however, we observed heterogeneity by age and sex; patients aged ≥50 years and females received higher doses and more prescriptions pre-PMP and experienced the greatest declines post-PMP.
Our study suggests that Iowa PMP implementation may have resulted in declines in OPR prescribing, and this impact varies by patient age and sex.
评估 2009 年实施的爱荷华州处方监测计划（PMP）对阿片类止痛药（OPR）处方模式的影响。
我们使用来自爱荷华州一家私人健康保险公司的 2003-2014 年健康保险索赔进行了中断时间序列分析。所有受益人均包括 OPR 处方。另一个数据集仅包括需要六个月保险覆盖的新阿片类药物使用者的 OPR 处方。我们评估了四种 OPR 处方模式：1）以吗啡毫克当量（MME）表示的平均每日剂量，2）每张处方的 MME，3）每张处方的平均供应天数，4）每千名参保人年的处方率。我们通过年龄和性别检查了 PMP 与处方模式之间关系的混杂因素和效果测量修饰。
在 12 年的随访期间，1512388 名参保爱荷华人共提供了 6169634.92 人年的随访。其中，505274 名患者开出了 2401818 张 OPR 处方，360688 名新 OPR 用户开出了同样数量的第一张 OPR 处方。从 2003 年到 2009 年，OPR 处方率的上升趋势在 PMP 之后下降。同样，每天和每张处方的 MME 也大幅下降。OPR 供应天数在 PMP 实施后仍在增加，尽管比 PMP 实施前的速度稍慢。年龄和性别没有混杂；然而，我们观察到年龄和性别存在异质性；年龄≥50 岁的患者和女性在 PMP 之前接受的剂量和处方更多，在 PMP 之后的下降幅度最大。
我们的研究表明，爱荷华州 PMP 的实施可能导致 OPR 处方减少，这种影响因患者年龄和性别而异。
