Zullich S G, Grasela T H, Fiedler-Kelly J B, Gengo F M
Department of Pharmacy, Erie County Medical Center, Buffalo, New York.
NIDA Res Monogr. 1993;131:294-308.
The addition of benzodiazepines to the triplicate prescription program in New York State was successful in reducing the use of benzodiazepines in a nursing home population, but the use of alternative agents was substantially increased. The reduction in benzodiazepine use could not be shown to be associated with any reduction in risk of adverse events during a retrospective review. In order to evaluate the impact of a triplicate prescription program on patient care, endpoints of efficacy as well as toxicity must be identified prior to the implementation of new legislation. It should be incumbent upon those States considering implementation of triplicate legislation to realize that the imposition of these regulations is tantamount to forced enrollment in a clinical trial for the patients affected by the legislation. A mechanism must be available to prospectively assess changes in prescribing patterns and their clinical consequences in order to determine objectively whether the legislative intervention was a success.
在纽约州的三联处方计划中增加苯二氮䓬类药物，成功减少了疗养院人群中苯二氮䓬类药物的使用，但替代药物的使用大幅增加。在回顾性审查中，无法证明苯二氮䓬类药物使用的减少与不良事件风险的任何降低相关。为了评估三联处方计划对患者护理的影响，在新立法实施之前，必须确定疗效和毒性的终点。那些考虑实施三联立法的州应该认识到，对受该立法影响的患者实施这些规定无异于强迫他们参加一项临床试验。必须有一个机制来前瞻性地评估处方模式的变化及其临床后果，以便客观地确定立法干预是否成功。
