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首页> 外文期刊>The Milbank quarterly >The Association of State Opioid Misuse Prevention Policies With Patient‐ and Provider‐Related Outcomes: A Scoping Review
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The Association of State Opioid Misuse Prevention Policies With Patient‐ and Provider‐Related Outcomes: A Scoping Review

机译：国家阿片类药物滥用预防策略与患者和提供者相关的结果：一个范围审查

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Policy Points This scoping review reveals a growing literature on the effects of certain state opioid misuse prevention policies, but persistent gaps in evidence on other prevalent state policies remain. Policymakers interested in reducing the volume and dosage of opioids prescribed and dispensed can consider adopting robust prescription drug monitoring programs with mandatory access provisions and drug supply management policies, such as prior authorization policies for high‐risk prescription opioids. Further research should concentrate on potential unintended consequences of opioid misuse prevention policies, differential policy effects across populations, interventions that have not received sufficient evaluation (eg, Good Samaritan laws, naloxone access laws), and patient‐related outcomes. Context In the midst of an opioid crisis in the United States, an influx of state opioid misuse prevention policies has provided new opportunities to generate evidence of policy effectiveness that can inform policy decisions.?We conducted a scoping review to synthesize the available evidence?on the effectiveness of US state interventions to improve patient and provider outcomes related to opioid misuse and addiction. Methods We searched six online databases to identify evaluations of state opioid policies. Eligible studies examined legislative and administrative policy interventions that evaluated (a) prescribing and dispensing, (b) patient behavior, or (c) patient health. Findings Seventy‐one articles met our inclusion criteria, including 41 studies published between 2016 and 2018. These articles evaluated nine types of state policies targeting opioid misuse. While prescription drug monitoring programs (PDMPs) have received considerable attention in the literature, far fewer studies addressed other types of state policy. Overall, evidence quality is very low for the majority of policies due to a small number of evaluations. Of interventions that have been the subject of considerable research, promising means of reducing the volume and dosages of opioids prescribed and dispensed include drug supply management policies and robust PDMPs. Due to low study number and quality, evidence is insufficient to draw conclusions regarding interventions targeting patient behavior and health outcomes, including naloxone access laws and Good Samaritan laws. Conclusions Recent research has improved the evidence base on several state interventions targeting opioid misuse. Specifically, moderate evidence suggests that drug supply management policies and robust PDMPs reduce opioid prescribing. Despite the increase in rigorous evaluations, evidence remains limited for the majority of policies, particularly those targeting patient health–related outcomes.
机译：政策点这个范围审查显示了某些国家阿片类药物滥用预防政策的影响的日益增长的文献，但仍然存在关于其他普遍州政策的证据的持续差距。有兴趣减少规定和分配的阿片类药物的体积和剂量的政策制定者可以考虑采用强制性的处方药监测计划，并获得强制性访问规定和药物供应管理政策，如先前的高风险处方表方人的授权政策。进一步的研究应专注于阿片类药物滥用预防政策的潜在意想不到的后果，跨越人口的差异政策效应，尚未获得足够评估的干预措施（例如，纯粹的撒玛利亚法律，纳诺酮访问法）和与患者有关的结果。背景信息在美国阿片类药物危机中，国家阿片类药物滥用预防政策的涌入为生成了政策效力的证据提供了新的机会，可以为政策决定提供通知政策效果。在综合可用证据的情况下进行了划分的审查，以综合可用证据？ON美国国家干预措施改善与阿片类药物滥用和成瘾相关的患者和提供者结果的有效性。方法搜索六个在线数据库，以确定国家阿片类药物的评估。符合条件的研究审查了评估（a）处方和分配的立法和行政政策干预措施，（b）患者行为，或（c）患者健康。调查结果七十一篇文章符合我们的纳入标准，其中包括2016年至2018年间发布的41项研究。这些文章评估了患有阿片类药物滥用的九种国家政策。虽然处方药监测计划（PDMPS）在文献中得到了相当大的关注，但研究涉及其他类型的国家政策。总体而言，由于少数评估，大多数政策都是非常低的证据质量。曾经是相当考试的主题的干预措施，有希望减少规定和分配的阿片类药物的体积和剂量包括药物供应管理政策和强大的PDMP。由于研究数量低，质量低，证据不足以得出针对患者行为和健康结果的干预措施的结论，包括纳诺酮访问法律和纯粹的撒玛利亚法律。结论最近的研究改善了针对阿片类药物滥用的几种国家干预措施的证据基础。具体而言，适度的证据表明，药物供应管理政策和强大的PDMPS会降低阿片类药物规定。尽管严格的评估增加，但证据仍然有限于大多数政策，特别是患者与患者健康相关结果的有限情况有限。

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