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首页> 外文期刊>Journal of general internal medicine >Impact of a State Opioid Prescribing Limit and Electronic Medical Record Alert on Opioid Prescriptions: a Difference-in-Differences Analysis
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Impact of a State Opioid Prescribing Limit and Electronic Medical Record Alert on Opioid Prescriptions: a Difference-in-Differences Analysis

机译：国家阿片类药物规定限制和电子病历警报对阿片类药物处方的影响：差异差异分析

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Background Prescribing limits are one policy strategy to reduce short-term opioid prescribing, but there is limited evidence of their impact. Objective Evaluate implementation of a state prescribing limit law and health system electronic medical record (EMR) alert on characteristics of new opioid prescriptions, refill rates, and clinical encounters. Design Difference-in-differences study comparing new opioid prescriptions from ambulatory practices in New Jersey (NJ) to controls in Pennsylvania (PA) from 1 year prior to the implementation of a NJ state prescribing limit (May 2016-May 2017) to 10 months after (May 2017-March 2018). Participants Adults with new opioid prescriptions in an academic health system with practices in PA and NJ. Interventions State 5-day opioid prescribing limit plus health system and health system EMR alert. Main Measures Changes in morphine milligram equivalents (MME) and tablet quantity per prescription, refills, and encounters, adjusted for patient and prescriber characteristics. Key Results There were a total of 678 new prescriptions in NJ and 4638 in PA. Prior to the intervention, median MME/prescription was 225 mg in NJ and 150 mg in PA, and median quantity was 30 tablets in both. After implementation, median MME/prescription was 150 mg in both states, and median quantity was 20 in NJ and 30 in PA. In the adjusted model, there was a greater decrease in mean MME and tablet quantity in NJ relative to PA after implementation of the policy plus alert (- 82.99 MME/prescription, 95% CI - 148.15 to - 17.84 and - 10.41 tabs/prescription, 95% CI - 19.70 to - 1.13). There were no significant differences in rates of refills or encounters at 30 days based on exposure to the interventions. Conclusions Implementation of a prescribing limit and EMR alert was associated with an approximately 22% greater decrease in opioid dose per new prescription in NJ compared with controls in PA. The combination of prescribing limits and alerts may be an effective strategy to influence prescriber behavior.
机译：背景规定限制是减少短期表征处方的一种政策策略，但有限的证据证明了它们的影响。客观评估国家规定限制法律和卫生系统电子医疗记录（EMR）提醒新的阿片类药物处方，再填充率和临床遭遇的提醒。设计差异研究差异研究比较新泽西州（NJ）在宾夕法尼亚州（PA）在实施NJ州规定限额前1年（2016年5月至2017年5月）至10个月的宾夕法尼亚州（PA）中的新阿片类药物的差异研究之后（2017年5月至2018年3月）。与PA和NJ的学术卫生系统中具有新阿片类药物的参与者成年人。干预状态5天阿片类药物规定限额加健康系统和卫生系统EMR警报。主要措施变化吗啡毫克当量（MME）和平板电脑数量，每次处方，重新填充和遇到，适用于患者和处方者特性。关键结果在宾夕法尼亚州的NJ和4638中共有678个新处方。在干预之前，中位MME /处方于NJ和150mg在PA中的150mg，两者中的中位数为30片。实施后，两种状态下的中位MME /处方为150毫克，中位数为NJ和PA中的30个。在调整后的模型中，在实施策略加警后，NJ的平均MME和平板电脑数量较大，在策略加警（ - 82.99mme /处方，95％CI-148.15至-17.84和 - 10.41标签/处方， 95％CI - 19.70至-1.13）。基于接触干预措施，30天内，重新填充物或遇到的率没有显着差异。结论在NJ中，在NJ中的每一种新的APIOID剂量减少约22％，与PA中的对照相比，该规定限额和EMR警报的实施与OPIODID剂量的减少约22％。规定限制和警报的组合可能是影响处方行为的有效策略。

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