College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, Texas, USA.
Prescription Drug Misuse Education and Research (PREMIER) Center, College of Pharmacy, University of Houston, Houston, Texas, USA.
Pharmacoepidemiol Drug Saf. 2021 Apr;30(4):492-503. doi: 10.1002/pds.5198. Epub 2021 Jan 31.
To describe Texas Prescription Monitoring Program (PMP) use and identify predictors of PMP query for opioid and benzodiazepine prescriptions by prescribers and pharmacists.
Dispensation and query records from the Texas PMP for opioid and benzodiazepine medications dispensed between October 1, 2016 and December 31, 2018 were linked using common patient identifiers. Autoregressive linear regression was used to assess trends in utilization. Hierarchical logistic models were specified to identify factors associated with provider and pharmacist query of opioid and benzodiazepine prescriptions.
Despite a significant increase in the total number of pharmacists (β = 169.85, p < 0.0001) and prescribers (β = 301.59, p < 0.0001) who used the PMP every month, the ratio of active to registered pharmacists (β = -0.0001, p = 0.75) and prescribers (β = -0.0015, p = 0.10) did not change. Pharmacists and prescribers were significantly more likely to query opioid and benzodiazepine prescriptions of 14 days or more, and those issued to patients new to their practice. Pharmacists were most likely to query opioid prescriptions for oxycodone (aOR = 4.51, 95%CI = 4.42-4.60) and prescribers were most likely to query prescriptions for buprenorphine (aOR = 2.24, 95%CI = 2.15-2.35) compared to codeine.
Changes in PMP utilization between October 2016 and December 2018 were driven by increasing registration, not increasing frequency of use among registered users. Use of the PMP is inconsistent and dependent upon patient characteristics thus limiting the utility of the PMP as a decision support tool. These results support the need for policy mandating PMP use in Texas and provide a useful baseline and framework to evaluate the effectiveness of mandate implementation.
描述德克萨斯州处方监测计划（PMP）的使用情况，并确定开处方医生和药剂师查询阿片类药物和苯二氮䓬类药物处方的预测因素。
使用共同的患者标识符，将 2016 年 10 月 1 日至 2018 年 12 月 31 日期间德克萨斯州 PMP 分发和查询记录进行链接。使用自回归线性回归评估使用趋势。指定分层逻辑模型以确定与提供者和药剂师查询阿片类药物和苯二氮䓬类药物处方相关的因素。
尽管每月使用 PMP 的药剂师（β=169.85，p<0.0001）和开处方医生（β=301.59，p<0.0001）的总数显着增加，但活跃药剂师（β=-0.0001，p=0.75）和开处方医生（β=-0.0015，p=0.10）的比例并未改变。药剂师和开处方医生更有可能查询阿片类药物和苯二氮䓬类药物处方，且这些处方的持续时间为 14 天或更长时间，并且这些处方是开给新患者的。药剂师最有可能查询羟考酮（阿片类药物）的处方（aOR=4.51，95%CI=4.42-4.60），而开处方医生最有可能查询丁丙诺啡（buprenorphine）的处方（aOR=2.24，95%CI=2.15-2.35）。
2016 年 10 月至 2018 年 12 月期间，PMP 使用情况的变化是由注册人数的增加驱动的，而不是注册用户使用频率的增加。PMP 的使用不一致，并且取决于患者特征，因此限制了 PMP 作为决策支持工具的实用性。这些结果支持在德克萨斯州强制使用 PMP 的政策，并提供了一个有用的基线和框架，以评估强制实施的效果。
