HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.
Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA.
Pain Med. 2021 Jul 25;22(7):1548-1558. doi: 10.1093/pm/pnaa386.
State prescription drug monitoring programs (PDMPs) identify controlled medications dispensed across providers and systems. Department of Veterans Affairs (VA) policy requires electronic health record documentation of PDMP queries at least annually for VA patients receiving controlled medications; however, queries are not uniformly conducted. We examined factors associated with PDMP queries for veterans receiving long-term opioid therapy.
Veterans with a VA provider who received long-term opioid therapy between August 2015 and August 2016 within a four-state region were identified; 9,879 were due for a PDMP query between August 2016 and February 2017. Likelihood of veterans' PDMP queries during this follow-up period was modeled as a function of patient, provider, and facility characteristics of interest in mixed-effects modified Poisson models estimating relative risk and 95% confidence intervals. Multivariable models controlled for potential confounders identified through the use of directed acyclic graphs.
PDMP queries were documented for 62.1% of veterans that were due for a PDMP query. Veterans were more likely to be queried if they were Hispanic or if they received methadone, had average daily milligram morphine equivalents >20, or received urine drug screening during the studied period. Veterans were less likely to be queried if they had a rural address, mail order medication, or cancer diagnosis. Likelihood of PDMP queries was also lower for veterans whose opioid-prescribing provider was an oncologist or working in a low-complexity facility.
Adherence to PDMP query policy within the VA varied by patient, clinician, and facility factors. Mechanisms to standardize the conduct of PDMP queries may be needed.
州处方药物监测计划（PDMP）识别在提供商和系统之间分发的受控药物。退伍军人事务部（VA）政策要求为接受受控药物治疗的 VA 患者至少每年在电子健康记录中记录 PDMP 查询；然而，查询并未统一进行。我们研究了与接受长期阿片类药物治疗的退伍军人 PDMP 查询相关的因素。
在四个州的区域内，确定了在 2015 年 8 月至 2016 年 8 月期间有 VA 提供商的接受长期阿片类药物治疗的退伍军人；2016 年 8 月至 2017 年 2 月期间，有 9879 名退伍军人需要进行 PDMP 查询。在这个随访期间，退伍军人 PDMP 查询的可能性被建模为患者、提供者和设施特征的函数，使用混合效应修正泊松模型估计相对风险和 95%置信区间。多变量模型通过使用有向无环图控制潜在的混杂因素。
在需要 PDMP 查询的退伍军人中，有 62.1%的退伍军人记录了 PDMP 查询。如果退伍军人是西班牙裔或接受美沙酮治疗、平均每日吗啡当量>20 毫克、或在研究期间接受尿液药物筛查，则更有可能被查询。如果退伍军人的地址是农村、邮购药物或患有癌症，则不太可能被查询。如果退伍军人的阿片类药物处方提供者是肿瘤学家或在低复杂度的医疗机构工作，则 PDMP 查询的可能性也较低。
VA 内 PDMP 查询政策的遵守情况因患者、临床医生和医疗机构因素而异。可能需要建立机制来规范 PDMP 查询的进行。
