同行比较或基于指南的反和术后阿片类药物处方:一项随机临床试验
Zachary Wagner1, Allison Kirkegaard1, Louis T Mariano2
1RAND Corporation, Santa Monica, California.
JAMA health forum
|March 15, 2024
概括
基于指南或同行比较的阿片类药物处方的电子邮件反,有效地减少了手术后的过量处方. 这些简单的干预措施可能有助于制下游阿片类药物滥用.
科学领域:
- 临床医学 临床医学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 手术后过度处方阿片类药物有助于长期使用和转移.
- 基于社会规范的干预措施在修改处方行为方面表现有前途.
研究的目的:
- 评估两种基于社会规范的干预措施在减少手术后与指南不一致的阿片类药物处方方面的有效性.
主要方法:
- 一个集群随机临床试验,涉及19个医院和3个外科专业.
- 干预措施包括与机构指南或同行外科医生相比的处方电子邮件反.
- 对照组没有接受任何干预;电子邮件针对的外科医生有>2个与指南不一致的处方.
主要成果:
- 与指南不一致的处方从对照组的36.8%下降到27.5% (同行比较) 和25.4% (指南).
- 同行比较和基于指导方针的反干预措施显著减少了分别5.8和4.7个百分点的指导方针不一致的处方.
- 干预效应在基线处方率和外科手术量较高的外科医生中最为明显.
结论:
- 电子邮件反干预,无论是指导方针还是基于同行,都有效地减少了外科后偏离指导方针的阿片类药物处方.
- 这些干预措施简单,低成本,可扩展,并有可能减轻下游阿片类药物滥用.
- 基于指导方针的反显示出与同行比较反相似的有效性.
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