学术细化提高了初级保健实践中药物监测计划的使用。
Academic detailing increases prescription drug monitoring program use among primary care practices.
出版信息
J Am Pharm Assoc (2003). 2021 Jul-Aug;61(4):418-424.e2. doi: 10.1016/j.japh.2021.02.019. Epub 2021 Mar 3.
OBJECTIVE
Clinical review of a prescription drug monitoring program (PDMP) is considered a valuable tool for opioid prescribing risk mitigation; however, PDMP use is often low, even in states with mandatory registration and use policies. The objective was to evaluate the impact of an academic detailing (AD) outreach intervention on PDMP use among primary care prescribers.
METHODS
AD intervention was delivered to primary care based controlled substance prescribers (N = 87) and their associated PDMP delegates (n = 42) by a clinical pharmacist as 1 component of a large-scale, statewide initiative to improve opioid prescribing safety. Prescriber PDMP use behavior was assessed by prescriber self-report and analysis of objective 2016-2018 PDMP data regarding the number of monthly report requests. We compared means between pre- and postintervention using a paired t test and plotted the monthly average reports over time to assess the trend of mean reports over time. Generalized linear mixed model with a negative binomial distribution was used to assess the difference in the trend and magnitude of the combined count of reports for the entire sample and prescriber subsets that were segmented on the basis of the adoption status of PDMP.
RESULTS
The monthly mean of reports by combined prescribers and delegates significantly increased after the AD intervention (mean 28.1 pre vs. 53.0 post; P < 0.001), with the increase in delegate reports (mean 17.1 pre vs. 60.0 post; P < 0.001) driving the overall increase. Reports were requested 40.4 times more often than in the preintervention period (P < 0.001). Patterns of pre- to postchanges in mean monthly report requests differed by baseline PDMP adoption status.
CONCLUSION
The AD intervention was transformative in facilitating practice change to use delegates to run reports. Visits with both prescribers and delegates, including hands-on PDMP training and registration assistance, can be viewed as beneficial for practice facilitation.
目的
临床审查处方药物监测计划（PDMP）被认为是减轻阿片类药物处方风险的有价值的工具；然而，即使在有强制性登记和使用政策的州，PDMP 的使用也往往很低。本研究的目的是评估学术细化（AD）外展干预对初级保健开方者使用 PDMP 的影响。
方法
临床药师向基于初级保健的受控物质开方者（N=87）及其相关 PDMP 代表（n=42）提供 AD 干预，这是全州范围内改善阿片类药物处方安全的大规模计划的一部分。通过开方者自我报告和分析 2016 年至 2018 年 PDMP 数据（关于每月报告请求的数量）来评估开方者 PDMP 使用行为。我们使用配对 t 检验比较干预前后的平均值，并绘制随时间变化的每月平均报告，以评估随时间变化的平均报告趋势。使用具有负二项式分布的广义线性混合模型评估整个样本和基于 PDMP 采用状态分段的开方者子集中报告的综合计数的趋势和幅度的差异。
结果
AD 干预后，联合开方者和代表的每月平均报告显著增加（平均 28.1 预 vs. 53.0 后；P<0.001），代表报告（平均 17.1 预 vs. 60.0 后；P<0.001）的增加推动了整体增加。报告的请求频率比干预前增加了 40.4 倍（P<0.001）。在 PDMP 采用状态的基础上，每月报告请求的预到后变化模式有所不同。
结论
AD 干预在促进使用代表运行报告的实践变革方面具有变革性。与开方者和代表的访问，包括 PDMP 的实践辅助和注册协助，可以被视为有利于实践促进。
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