Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.
Musculoskeletal Health and Sustainable Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Br J Clin Pharmacol. 2024 Apr;90(4):1162-1172. doi: 10.1111/bcp.15996. Epub 2024 Feb 2.
This study aimed to evaluate whether voluntary and mandatory prescription drug monitoring program (PDMP) use in Victoria, Australia, had an impact on prescribing behaviour, focusing on individual patients' prescribed opioid doses and transition to prescribing of nonmonitored medications.
This was a retrospective cross-sectional study using routinely collected primary healthcare data. A 90-day moving average prescribed opioid dose in oral morphine equivalents was used to estimate opioid dosage. A Markov transition matrix was used to describe how patients prescribed medications transitioned between opioid dose groups and other nonopioid treatment options during 3 transition periods: transition between 2 control periods prior to PDMP implementation (T1 to T2); during the voluntary PDMP implementation (T2 to T3); and during mandatory PDMP implementation (T3 to T4).
Among patients prescribed opioids in our study, we noted an increased probability of transitioning to not being prescribed opioids during the mandatory PDMP period (T3 to T4). This increase was attributed mainly to the ceasing of low-dose opioid prescribing. Membership in an opioid dose group remained relatively stable for most patients who were prescribed high opioid doses. For those who were only prescribed nonmonitored medications initially, the probability of being prescribed opioids increased during the mandatory PDMP when compared to other transition periods.
The introduction of PDMP mandates appeared to have an impact on the prescribing for patients who were prescribed low-dose opioids, while its impact on individuals prescribed higher opioid doses was comparatively limited.
本研究旨在评估澳大利亚维多利亚州自愿和强制使用处方药物监测计划（PDMP）对处方行为的影响，重点关注个体患者的处方阿片类药物剂量和向非监测药物处方的转变。
这是一项使用常规收集的初级保健数据进行的回顾性横断面研究。使用口服吗啡等效物的 90 天移动平均处方阿片类药物剂量来估计阿片类药物剂量。使用马尔可夫转移矩阵来描述患者在 3 个转移期内如何在阿片类药物剂量组和其他非阿片类治疗选择之间过渡：在 PDMP 实施之前的 2 个对照期之间（T1 到 T2）进行转移；在自愿 PDMP 实施期间（T2 到 T3）；在强制 PDMP 实施期间（T3 到 T4）。
在我们研究中接受阿片类药物处方的患者中，我们注意到在强制 PDMP 期间，不被处方阿片类药物的可能性增加（T3 到 T4）。这种增加主要归因于低剂量阿片类药物处方的停止。对于大多数被处方高剂量阿片类药物的患者，他们所在的阿片类药物剂量组的成员身份相对稳定。对于那些最初只被处方非监测药物的患者，与其他转移期相比，在强制 PDMP 期间被处方阿片类药物的可能性增加。
PDMP 强制实施似乎对被处方低剂量阿片类药物的患者的处方产生了影响，而对被处方高剂量阿片类药物的个体的影响相对有限。
