Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
JAMA Surg. 2018 Dec 1;153(12):1105-1110. doi: 10.1001/jamasurg.2018.2666.
Most states have adopted the routine use of a prescription drug monitoring program (PDMP) to curb overprescribing of opioids. The American College of Surgeons promotes the use of these programs as a "guiding principle to curb the opioid epidemic." However, there is a paucity of data on the effects of the use of these programs for surgical patient populations.
To determine the association of the mandatory use of a PDMP with the opioid prescribing practices for patients undergoing general surgery.
DESIGN, SETTING, AND PARTICIPANTS: A prospective observational cohort study was conducted at an academic hospital in New Hampshire among 1057 patients undergoing representative elective general surgical procedures from July 1, 2016, to June 30, 2017.
New state legislation mandated the use of a PDMP and opioid risk-assessment tool for all patients receiving an outpatient opioid prescription in New Hampshire beginning January 1, 2017. The electronic medical prescribing system was modified to facilitate and support compliance with the new requirements.
Change in opioid prescribing practices after January 1, 2017, and time to complete PDMP requirements.
Among the 1057 patients (569 women [53.8%] and 488 men [46.2%]; mean [SD] age, 56.8 [15.4] years), the percentage of patients prescribed opioids after surgery did not decrease significantly (429 of 536 [80.0%] before the new requirements vs 401 of 521 [77.0%] after the requirements; P = .29). The mean number of opioid pills prescribed decreased from 30.8 to 24.0 (22.1%) in the 6 months prior to the mandatory PDMP requirement; the rate of decrease was actually less (from 22.8 to 21.9 pills [3.9%]) in the 6 months after the legislation. These new requirements did not identify any high-risk patients who subsequently were not prescribed opioids. The query and opioid abuse risk calculator together took a median time of 7 minutes (range, 2-17 minutes) to complete.
A mandatory PDMP query requirement was not significantly associated with the overall rate of opioid prescribing or the mean number of pills prescribed for patients undergoing general surgical procedures. In no cases was a high-risk patient identified, leading to avoidance of an opioid prescription. A PDMP can be a useful adjunct in certain settings, but this study found that it did not have the intended effect in a population undergoing elective surgical procedures. Legislative efforts to mandate PDMP use should be targeted to populations in which benefit can be demonstrated.
大多数州已经采用了处方药物监测计划（PDMP）的常规使用，以遏制阿片类药物的过度处方。美国外科医师学院提倡将这些计划用作“遏制阿片类药物流行的指导原则”。然而，对于手术患者人群使用这些计划的效果数据很少。
确定强制性使用 PDMP 与接受普通外科手术的患者的阿片类药物处方实践之间的关联。
设计、地点和参与者：在新罕布什尔州的一家学术医院进行了一项前瞻性观察队列研究，纳入了 2016 年 7 月 1 日至 2017 年 6 月 30 日期间接受代表性选择性普通外科手术的 1057 名患者。
新的州立法要求自 2017 年 1 月 1 日起，新罕布什尔州所有接受门诊阿片类药物处方的患者必须使用 PDMP 和阿片类药物风险评估工具。修改了电子医嘱系统，以促进和支持遵守新要求。
2017 年 1 月 1 日之后阿片类药物处方实践的变化以及完成 PDMP 要求的时间。
在 1057 名患者中（536 名女性[53.8%]和 488 名男性[46.2%]；平均[SD]年龄为 56.8[15.4]岁），手术后开具阿片类药物处方的患者比例没有显著下降（新要求前为 536 名中的 429 名[80.0%]，新要求后为 521 名中的 401 名[77.0%]；P = .29）。在强制性 PDMP 要求之前的 6 个月中，开处的阿片类药物丸数从 30.8 减少到 24.0（22.1%）；立法后，减少的速度实际上更慢（从 22.8 到 21.9 丸[3.9%]）。这些新要求并未发现任何随后未开具阿片类药物处方的高风险患者。查询和阿片类药物滥用风险计算器总共需要 7 分钟（范围为 2-17 分钟）才能完成。
强制性 PDMP 查询要求与接受普通外科手术的患者总体阿片类药物处方率或开具的平均药丸数没有显著关联。在任何情况下都没有发现高风险患者，从而避免了阿片类药物处方。PDMP 可以在某些情况下作为有用的辅助手段，但本研究发现，它在接受择期手术的人群中没有产生预期的效果。要求使用 PDMP 的立法工作应针对可以证明受益的人群。
