Monitoring Multiple Prescriptions from Different Doctors May Cut Overdose Deaths

Aaron: 处方药监测，下一期《大发娱乐提供》节目.

播音员: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. 您正在收听的是范围.

Aaron: 我和Peter Kreiner博士在一起, he's a senior scientist at the Institute of Behavioral Health of the Schneider Institutes for Health Policy, a researcher for the Heller School for Social Policy and Management and he's an expert in prescription drug monitoring. 欢迎博士. Kreiner.

Dr. Kreiner: 谢谢你,艾伦.

处方过量死亡

Aaron: Dr. Kreiner, 在犹他州, deaths due to prescription overdose have been increasing since about 2001 and we have about 21 Utahans die from prescription overdose every month. 这是一个全国性的问题吗?

Dr. Kreiner: 当然是，亚伦. 可能从21世纪初开始, public health officials started recognizing opioid and prescription drug overdose death as a huge and increasing problem and recognition has just grown from there. 所以在过去的几年里, 所有联邦机构和国家组织, state governments have grown increasingly concerned with the problem and have started reaching out in a lot of different directions to look for solutions.

Aaron: a是什么？ 处方药监测计划? 我知道这是他们正在考虑的解决方案之一.

处方监测项目

Dr. Kreiner: 处方监控程序本质上是一个数据存储库. 目前已有49个州通过立法，授权实施这一项目. 48个州有实际运作的项目. The hold outs are Missouri for legislation and New Hampshire is just about to have an operating program. They're repositories of filled or dispensed prescriptions for controlled substances that 药店 是否需要提交给每个州的项目. 所以它们是为多个利益相关者服务的数据库, typically prescribers and pharmacists and often other individuals can establish an account with a prescription monitoring program and log in and query it about a patient to inform their clinical decision making.
In many states law enforcement can access the data in relation to an active case investigation and increasingly the value of this data is being recognized and so monitoring programs are providing data to other entities like medical examiners, 毒品法庭, 跟踪他们的一些客户. Treatment facilities are accessing the data to see if patients in treatment facilities might be obtaining prescriptions that their clinicians don't know about. So there's a lot of innovation going on now across the country about use of this data

监控程序记录什么数据?

Aaron: 这些监控程序维护的是什么样的数据?

Dr. Kreiner: 这是每份处方的记录, 包括病人的信息, 开药者, 以及配药的药房, 包括开处方的日期, 配药日期和具体药物的信息, 剂量, 供货日期, 通常是不管是否续杯或者是否允许续杯. 在许多州，它包括有关付款来源的信息. 保险，现金之类的东西.

患者安全

Aaron: 这个项目对患者安全的整体价值是什么?

Dr. Kreiner: 为了病人的安全, 如果病人出示处方医生或他们的医生, 可能是急诊室，也可能是他们的初级保健医生, that physician may or may not know about the prescription history of that patient. Often physicians think this is a legitimate patient, have legitimate symptoms. I'm interested in prescribing a pain medication opioid analgesics and yet when they check the monitoring program, they find that person may have obtained half a dozen prescriptions from a number of different prescribers in the last month. 这是一个非常不同的病人的照片，他们可能有.

Aaron: So ultimately this can help a health care provider help a patient stop an addiction or at least get help for an addiction before it goes too far. 这样说有把握吗?

Dr. Kreiner: Patients may be obtaining multiple prescriptions for lots of different reasons. So they may be misusing or abusing, they may be addicted, they may be diverting. 当然还有开处方的人, it's intended that they might have a discussion with that patient and really try to help that patient to seek appropriate help. It's an ongoing issue about what treatment resources are available and that's an issue in every state.

Aaron: 犹他州有一个处方药监控项目. 我不知道你对犹他大学的特殊项目有多熟悉, 但根据你在全国的经历来看, how do you think Utah could better use its 处方药监测计划 to prevent overdosing?

Dr. Kreiner: 大发娱乐的中心, so we have a 处方药监测计划 center of excellence at Brandeis University, studies best and promising innovative practices that monitoring programs are doing nation wide. 所以大发娱乐发现了一些奇怪的做法，这些做法一直在增加. Some of the more impactful ones that we've seen in other states that I believe Utah is not currently implementing include what's called unsolicited reporting where a monitoring program proactively analyzes this data and pushes out a report or sometimes an electronic alert to a prescriber or pharmacist for a patient to bring that information to their attention.
Several states have enacted mandates for prescribers and or pharmacists to register with the program and query it under specified conditions. 比如最近的纽约, Kentucky, 尽管这些项目都是最近才开始的, 它已经对该计划的使用量产生了影响. But also in certain indicators of doctor pharmacy shopping and opioid prescribing.

Some other practices that seem very valuable that we've been using in Massachusetts is use of de-identified prescription monitoring program for public health surveillance purposes in particular to provide it to counties and communities, 大发娱乐正在努力防止和减少处方用药过量, 与处方药有关的问题. I could go on, but those are some leading practices that I think Utahans could benefit from.

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