《减少急性疼痛开具延长释放型阿片类药物的管控干预措施的有效性：系统评价》。

The Effectiveness of Stewardship Interventions to Reduce the Prescribing of Extended-Release Opioids for Acute Pain: A Systematic Review.

机构信息

The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia.

出版信息

Pain Med. 2020 Oct 1;21(10):2401-2411. doi: 10.1093/pm/pnaa139.

DOI:10.1093/pm/pnaa139

PMID:32488237

Abstract

OBJECTIVE

To evaluate the effectiveness of stewardship interventions in reducing the prescribing of extended-release opioids for acute pain.

DESIGN

Systematic review of randomized controlled trials, pre-post intervention studies, cohort studies and case-control studies.

METHODS

A search was conducted using Medline, Scopus, Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts, and PsycINFO from inception to March 24, 2019. Search terms included opioids, interventions, extended-release, and acute pain. Included articles were original research articles outlining the impact of stewardship interventions on reducing the prescribing of extended-release opioids for acute pain.

RESULTS

The search resulted in 1,264 articles after the removal of duplicates. Of these, 141 full texts were assessed, with three eligible for inclusion. One additional article was obtained via a manual search. Three studies explored forcing function interventions; two included prior authorization policies, which saw decreases in extended-release/long-acting scripts by 18-36%, while another evaluated order restrictions producing increased adherence to guidelines by 36%. One study explored the impact of education targeting prescribers and patients through a risk mitigation and evaluation strategy, which decreased extended-release/long-acting quarterly script volumes by 4.3%. All studies were performed at system levels. Forcing function interventions decreased extended-release/long-acting prescriptions and increased adherence to guidelines to a greater extent than less restrictive interventions such as education.

CONCLUSIONS

Forcing function interventions implemented at system levels show promise in decreasing the prescribing of extended-release opioids for acute pain. The current lack of literature warrants future research to increase understanding of the effectiveness of such interventions.

摘要

目的

评估管理干预措施在减少急性疼痛时开具延长释放型阿片类药物的效果。

设计

系统评价随机对照试验、干预前后研究、队列研究和病例对照研究。

方法

从建库到 2019 年 3 月 24 日，使用 Medline、Scopus、Cochrane 对照试验中心注册库、国际药学文摘和 PsycINFO 进行检索。检索词包括阿片类药物、干预措施、延长释放和急性疼痛。纳入的文章为概述管理干预措施对减少急性疼痛时开具延长释放型阿片类药物的影响的原始研究文章。

结果

去除重复项后，检索共得到 1264 篇文章。其中，有 141 篇全文进行了评估，有 3 篇符合纳入标准。另外通过手工检索获得 1 篇文章。3 项研究探讨了强制功能干预措施；其中 2 项包括事先授权政策，使延长释放/长效处方减少 18-36%，而另一项评估的订单限制使遵循指南的比例增加 36%。1 项研究通过风险缓解和评估策略，评估了针对医生和患者的教育对减少延长释放/长效处方的影响，使延长释放/长效处方的季度处方量减少了 4.3%。所有研究均在系统层面进行。与教育等限制较少的干预措施相比，强制功能干预措施可更有效地减少急性疼痛时开具延长释放/长效处方的情况，并增加对指南的遵循。