EFFECTIVENESS OF PRESCRIPTION MONITORING PROGRAM USE IN EMERGENCY DEPARTMENTS

急诊科使用处方监测计划的有效性

基本信息

批准号：
8810236
负责人：
Benjamin C Sun
金额：
$ 34.21万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-03-01 至 2018-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8810236
关键词：
Accident and Emergency department Accounting Acute Pain Address Adoption Alcohol or Other Drugs use Centers for Disease Control and Prevention (U.S.)Cessation of life Cocaine Collaborations Congresses County Hospitals Data Data Set Diagnosis Effectiveness Emergency Care Emergency department visit Epidemic Evaluation Future Goals Health Healthcare Heroin Hospitals Individual Information Systems Institutes Intervention Knowledge Link Medicaid Monitor National Institute of Drug Abuse Nature Opioid Outcome Overdose Patients Pharmaceutical Preparations Pharmacy facility Physician-Patient Relations Physicians Policies Population Provider Public Health Reporting Resources Source Time United States National Institutes of Health Vehicle crash Washington authority beneficiary database design disorder prevention drug abuser effective intervention high risk improved meetings mortality novel operation opioid abuse overdose death prescription drug abuse prescription opioid prescription opioid abuse pressure programs trend

项目摘要

DESCRIPTION (provided by applicant): The ultimate goal of this proposal is to reduce prescription opioid related overdoses and deaths. The U.S. Congress, the National Institute on Drug Abuse, and the Centers for Disease Control and Prevention have identified prescription opioid abuse as a top public health problem. The 14,800 prescription opioid-related overdose deaths reported in 2008 have increased five-fold since 1999 and far surpass overdose deaths from cocaine and heroin. Emergency departments (ED) are the source of 39% of prescriptions for controlled substances and represent particularly high risk settings for doctor shopping and drug diversion. Contributing factors include the episodic and time-pressured nature of emergency care, lack of a long-term physician- patient relationship, and until recently, the absence of integrated data systems about prior controlled substance use. Prescription monitoring programs (PMPs) are statewide pharmacy databases designed to limit drug misuse by providing data on controlled medication dispensing. Despite the considerable expense of PMPs, the data on their impact to reduce opioid related harms are limited. A major challenge to the effectiveness and evaluation of PMPs is low rates of physician adoption; less than 6% of eligible providers will register for PMP access in the first year of operation. Washington State recently mandated that ED providers register for PMP access by July 2012; all 87 eligible hospitals have met this requirement. Although the policy does not require PMP use, it does create universal provider PMP access in a high risk setting. We capitalize on this opportunity to study a critical public health question: Does PMP use in emergency departments reduce opioid prescribing, overdoses, and deaths? In collaboration with the Washington State Health Care Authority and the Washington State Prescription Monitoring Program, we will create a unique dataset linking provider PMP use, opioid prescribing, and outcomes to accomplish the following Aims: Specific Aim 1. Identify predictors of PMP use by emergency department providers Specific Aim 2. Assess the impact of emergency department PMP use on total, inappropriate, and appropriate opioid prescribing Specific Aim 3. Assess the impact of emergency department PMP use on patient outcomes. To achieve these Aims, we will create a unique dataset of 2,400 providers and 1.4 million ED visits that links provider PMP use to patient claims and mortality files. Our proposal will result in novel and policy-relevant knowledge to address the public health epidemic of prescription opioid abuse.

描述（由申请人提供）：该提案的最终目标是减少处方阿片类药物相关的过量用药和死亡。美国国会、国家药物滥用研究所和疾病控制与预防中心已将处方阿片类药物滥用视为首要公共卫生问题。 2008 年报告的 14,800 例处方阿片类药物过量死亡人数自 1999 年以来增加了五倍，远远超过可卡因和海洛因过量死亡。急诊科 (ED) 是 39% 受控药物处方的来源，是医生购物和药物转移的高风险环境。促成因素包括紧急护理的间歇性和时间紧迫性、缺乏长期的医患关系，以及直到最近还缺乏有关先前受控药物使用的综合数据系统。处方监控计划 (PMP) 是全州范围的药房数据库，旨在通过提供有关受控药物配药的数据来限制药物滥用。尽管 PMP 的费用相当大，但有关其减少阿片类药物相关危害的影响的数据仍然有限。 PMP 有效性和评估的一个主要挑战是医生采用率低；不到 6% 的合格提供商会在运营第一年注册 PMP 访问权限。华盛顿州最近强制要求 ED 提供者在 2012 年 7 月之前注册 PMP 访问权限；所有87家符合条件的医院均满足这一要求。尽管该策略不要求使用 PMP，但它确实在高风险环境中创建了通用提供商 PMP 访问权限。我们利用这个机会研究一个关键的公共卫生问题：急诊科使用 PMP 是否会减少阿片类药物处方、用药过量和死亡？我们将与华盛顿州卫生保健局和华盛顿州处方监测计划合作，创建一个独特的数据集，将提供商 PMP 使用、阿片类药物处方和结果联系起来，以实现以下目标：具体目标 1. 确定紧急情况下 PMP 使用的预测因素科室提供者具体目标 2. 评估急诊科 PMP 使用对总体、不适当和适当阿片类药物处方的影响具体目标 3. 评估急诊科 PMP 使用对患者的影响结果。为了实现这些目标，我们将创建一个包含 2,400 家提供者和 140 万次急诊就诊的独特数据集，将提供者 PMP 的使用与患者索赔和死亡率文件联系起来。我们的提案将产生新颖且与政策相关的知识，以解决处方阿片类药物滥用的公共卫生流行问题。