Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, Bldg. 58, North Little Rock, AR, 72114, USA.
Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 782, Little Rock, AR, 72205, USA.
J Prev (2022). 2022 Jun;43(3):337-357. doi: 10.1007/s10935-022-00670-7. Epub 2022 Feb 3.
Effective means of accurately identifying problematic opioid prescribing are needed. Using an iterative approach with the Arkansas State Medical Board Pain Subcommittee, we modified existing opioid prescriber criteria to create seven metrics to be deployed in Arkansas. These included metrics of dose and days' supply, concomitant use of opioid and benzodiazepines, solid dosage units, and numbers of opioid patients and certain opioid prescriptions. Two of these metrics (average MME daily dose per prescription and total oxycodone 30 mg or hydromorphone prescriptions) were weighted by 2, creating a maximum score of 9 of which each prescriber could receive. Twenty prescribers with a score of 7 or greater were identified and referred to the Arkansas State Medical Board Pain Subcommittee for review and subsequent investigation if deemed necessary. Of those 20 prescribers, four were previously investigated and under disciplinary action, and three were under current investigation for misconduct related to prescribing practices. Five prescribers had new investigations opened due to the findings from the metrics, and disciplinary action was taken. Therefore, 12 of the 20 prescribers referred to the Arkansas State Medical Board were deemed worthy of investigation and disciplinary action. The Arkansas opioid prescriber metrics are able to accurately identify prescribers with potentially problematic opioid prescribing.
需要有效的方法来准确识别有问题的阿片类药物处方。我们与阿肯色州医学委员会疼痛小组委员会一起采用迭代方法，修改了现有的阿片类药物处方者标准，创建了将在阿肯色州部署的七个指标。这些指标包括剂量和供应天数、阿片类药物和苯二氮䓬类药物的同时使用、固体制剂单位、阿片类药物患者数量和某些阿片类药物处方数量。其中两个指标（每个处方的平均 MME 日剂量和总羟考酮 30 毫克或氢吗啡酮处方）的权重为 2，每个处方者的最高得分为 9。确定了 20 名得分在 7 分或以上的处方者，并将其转交给阿肯色州医学委员会疼痛小组委员会审查，如果认为有必要，随后进行调查。在这 20 名处方者中，有 4 名之前已经接受过调查和纪律处分，有 3 名目前因与处方实践相关的不当行为正在接受调查。由于这些指标的调查结果，有 5 名处方者的新调查已经展开，并采取了纪律处分措施。因此，在转交给阿肯色州医学委员会的 20 名处方者中，有 12 名被认为值得调查和采取纪律处分措施。阿肯色州阿片类药物处方者指标能够准确识别出可能存在问题的阿片类药物处方者。
