Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Gen Intern Med. 2018 Aug;33(8):1253-1259. doi: 10.1007/s11606-018-4374-1. Epub 2018 Mar 8.
The Department of Veterans Affairs (VA) has implemented robust strategies to monitor prescription opioid dispensing, but these strategies have not accounted for opioids prescribed by non-VA providers. State-based prescription drug monitoring programs (PDMPs) are a potential tool to identify VA patients' receipt of opioids from non-VA prescribers, and recent legislation requires their use within VA.
To evaluate VA physicians' perspectives and experiences regarding use of PDMPs to monitor Veterans' receipt of opioids from non-VA prescribers.
Qualitative study using semi-structured interviews.
Forty-two VA primary care physicians who prescribed opioids to 15 or more Veterans in 2015. We sampled physicians from two states with PDMPs (Massachusetts and Illinois) and one without prescriber access to a PDMP at the time of the interviews (Pennsylvania).
From February to August 2016, we conducted semi-structured telephone interviews that addressed the following topics regarding PDMPs: overall experiences, barriers to optimal use, and facilitators to improve use.
VA physicians broadly supported use of PDMPs or desired access to one, while exhibiting varying patterns of PDMP use dictated by state laws and their clinical judgment. Physicians noted administrative burdens and incomplete or unavailable prescribing data as key barriers to PDMP use. To facilitate use, physicians endorsed (1) linking PDMPs with the VA electronic health record, (2) using templated notes to document PDMP use, and (3) delegating routine PDMP queries to ancillary staff.
Despite the time and administrative burdens associated with their use, VA physicians in our study broadly supported PDMPs. The application of our findings to ongoing PDMP implementation efforts may strengthen PDMP use both within and outside VA and improve the safe prescribing of opioids.
美国退伍军人事务部（VA）已经实施了强有力的策略来监测处方类阿片类药物的发放情况，但这些策略并未考虑到非 VA 提供商开出的阿片类药物。州级处方药物监测计划（PDMP）是一种潜在的工具，可以确定 VA 患者从非 VA 开处方者处获得阿片类药物的情况，最近的立法要求在 VA 内使用 PDMP。
评估 VA 医生对使用 PDMP 来监测退伍军人从非 VA 开处方者处获得阿片类药物的看法和经验。
使用半结构化访谈的定性研究。
42 名在 2015 年为 15 名或以上退伍军人开处阿片类药物的 VA 初级保健医生。我们从有 PDMP 的两个州（马萨诸塞州和伊利诺伊州）和一个在访谈时没有开处方者获取 PDMP 权限的州（宾夕法尼亚州）抽取医生。
从 2016 年 2 月到 8 月，我们进行了半结构化电话访谈，这些访谈涉及 PDMP 的以下主题：总体经验、最佳使用的障碍以及改善使用的促进因素。
VA 医生广泛支持使用 PDMP 或希望获得 PDMP，同时根据州法律和他们的临床判断，表现出不同的 PDMP 使用模式。医生指出行政负担和不完整或不可用的处方数据是 PDMP 使用的主要障碍。为了促进使用，医生们赞成（1）将 PDMP 与 VA 电子健康记录链接，（2）使用模板笔记记录 PDMP 使用情况，以及（3）将常规 PDMP 查询委托给辅助人员。
尽管使用 PDMP 会带来时间和行政负担，但我们研究中的 VA 医生普遍支持 PDMP。将我们的研究结果应用于正在进行的 PDMP 实施工作中，可能会加强 PDMP 在 VA 内外的使用，并改善阿片类药物的安全处方。
