Division of Hospital Medicine, Department of Medicine, Emory Palliative Care Center, Emory University School of Medicine, Atlanta, Georgia.
Division of General Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia.
J Palliat Med. 2019 Sep;22(9):1115-1119. doi: 10.1089/jpm.2018.0638. Epub 2019 Apr 22.
Responding to an epidemic of opioid-related deaths, guidelines and laws have been implemented to promote safe opioid prescribing practices. This study evaluates differences in screening practices and knowledge of laws between oncologists and cardiologists who prescribe opiates. Surveys regarding screening practices and knowledge of opioid prescribing laws were distributed in March 2017 to oncology and congestive heart failure (CHF) clinicians at the University of Virginia. Chi-square and Wilcoxon rank sum tests were used. Forty-six of 129 (35.6%) oncology providers and 7 of 14 (50%) CHF providers reported prescribing opiates in their clinic with usable survey results. The majority of oncology (65.22%) and cardiology (85.71%) providers report screening for substance abuse "when indicated" ( = 0.053). Only 19.6% of oncologists reported always using the prescription monitoring program (PMP), while 71.43% of cardiologists reported using it always ( = 0.014). Of the oncology providers, 66.67% report never using the urine drug screen (UDS), while 86.7% of cardiologists reported using it "when indicated" ( = 0.0086). Up to 34.78% of the oncologists and 57.14% of the cardiologists reported of never screening the family members for misuse ( = 0.317). Knowledge of laws was similar between groups, with 14.29% of cardiology and 17.39% of oncology providers reporting no knowledge of opioid prescribing laws ( = 0.2869). Routine screening for substance misuse risk was uncommon for both groups, but cardiology providers were more likely to use the PMP or UDS. Knowledge gaps regarding Virginia laws were noted in both groups. Improved education regarding best practices and laws, as well as programs to promote screening, is needed for all providers.
针对阿片类药物相关死亡的流行，已实施了指南和法规，以促进安全的阿片类药物处方实践。本研究评估了开具阿片类药物的肿瘤学家和心脏病专家之间在筛查实践和阿片类药物处方法规知识方面的差异。2017 年 3 月，向弗吉尼亚大学的肿瘤学和充血性心力衰竭 (CHF) 临床医生分发了关于筛查实践和阿片类药物处方法规知识的调查问卷。使用卡方检验和 Wilcoxon 秩和检验。129 名肿瘤科医生中有 46 名（35.6％）和 14 名 CHF 医生中有 7 名（50％）报告在其诊所中开具阿片类药物，调查结果可用。大多数肿瘤学（65.22％）和心脏病学（85.71％）提供者报告在“有指征”时筛查物质滥用（=0.053）。只有 19.6％的肿瘤学家报告始终使用处方监测计划（PMP），而 71.43％的心脏病学家报告始终使用它（=0.014）。在肿瘤科医生中，有 66.67％的人报告从未使用尿液药物筛查（UDS），而有 86.7％的心脏病医生报告在“有指征”时使用它（=0.0086）。多达 34.78％的肿瘤学家和 57.14％的心脏病学家报告从未对家庭成员进行药物滥用筛查（=0.317）。两组之间的法律知识相似，14.29％的心脏病学和 17.39％的肿瘤学医生报告不了解阿片类药物处方法规（=0.2869）。两组患者都很少进行常规的物质滥用风险筛查，但心脏病学医生更有可能使用 PMP 或 UDS。两组都注意到弗吉尼亚州法律方面的知识差距。所有提供者都需要加强有关最佳实践和法规的教育，并制定促进筛查的计划。
