Victor Puac-Polanco, Stanford Chihuri, David S Fink, Magdalena Cerdá, Katherine M Keyes, Guohua Li
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引用次数: 30
摘要
处方药监测项目(PDMPs)是联邦和州政府应对阿片类药物流行的重要组成部分。关于PDMPs在减少处方阿片类药物相关不良后果方面的有效性的证据参差不齐。我们进行了一项系统综述,以检查PDMP在美国的实施是否与4个处方阿片类药物相关结果领域的变化有关:阿片类药物处方行为、阿片类药物转移和供应、阿片类药物相关发病率和物质使用障碍以及阿片类药物相关死亡。我们在Embase、Google Scholar、MEDLINE和Web of Science中搜索了符合条件的出版物。2009年至2019年间发表的29项研究符合纳入标准。在16项检查PDMPs和处方行为的研究中,11项发现实施PDMPs减少了处方行为。关于阿片类药物转移和供应的所有3项研究都报告了所检查结果的减少。在阿片类药物相关发病率和物质使用障碍领域,8项研究中有7项发现了与处方阿片类药物相关结果的关联。在阿片类药物相关死亡领域的8项研究中,有4项报告死亡率降低。尽管结果喜忧参半,但新出现的证据支持,国家PDMPs的实施减少了阿片类药物处方、阿片类药物的转移和供应,以及阿片类药物相关的发病率和物质使用障碍的结果。当检查PDMP特征时,强制性获取规定与处方行为、转移结果、住院率、物质使用障碍和死亡率的减少有关。结果领域之间证据基础的不一致是由于不同研究的分析方法,以及在某种程度上,不同州和不同时期实施的PDMP政策的异质性。
Prescription Drug Monitoring Programs and Prescription Opioid-Related Outcomes in the United States.
Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments' response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid-related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid-related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid-related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.
期刊介绍:
Epidemiologic Reviews is a leading review journal in public health. Published once a year, issues collect review articles on a particular subject. Recent issues have focused on The Obesity Epidemic, Epidemiologic Research on Health Disparities, and Epidemiologic Approaches to Global Health.