scholarly journals Factors Related to Prescription Drug Monitoring Program Queries for Veterans Receiving Long-Term Opioid Therapy

Pain Medicine ◽  
2020 ◽  
Author(s):  
Sarah B Andrea ◽  
Tess A Gilbert ◽  
Benjamin J Morasco ◽  
Somnath Saha ◽  
Kathleen F Carlson
Keyword(s):  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Low Complexity ◽  
Opioid Therapy ◽  
Directed Acyclic Graphs ◽  
Department Of Veterans Affairs ◽  
Prescription Drug Monitoring Programs ◽  
Urine Drug

Abstract Objective State prescription drug monitoring programs (PDMPs) identify controlled medications dispensed across providers and systems. Department of Veterans Affairs (VA) policy requires electronic health record documentation of PDMP queries at least annually for VA patients receiving controlled medications; however, queries are not uniformly conducted. We examined factors associated with PDMP queries for veterans receiving long-term opioid therapy. Methods Veterans with a VA provider who received long-term opioid therapy between August 2015 and August 2016 within a four-state region were identified; 9,879 were due for a PDMP query between August 2016 and February 2017. Likelihood of veterans’ PDMP queries during this follow-up period was modeled as a function of patient, provider, and facility characteristics of interest in mixed-effects modified Poisson models estimating relative risk and 95% confidence intervals. Multivariable models controlled for potential confounders identified through the use of directed acyclic graphs. Results PDMP queries were documented for 62.1% of veterans that were due for a PDMP query. Veterans were more likely to be queried if they were Hispanic or if they received methadone, had average daily milligram morphine equivalents >20, or received urine drug screening during the studied period. Veterans were less likely to be queried if they had a rural address, mail order medication, or cancer diagnosis. Likelihood of PDMP queries was also lower for veterans whose opioid-prescribing provider was an oncologist or working in a low-complexity facility. Conclusions Adherence to PDMP query policy within the VA varied by patient, clinician, and facility factors. Mechanisms to standardize the conduct of PDMP queries may be needed.

scholarly journals Examining the Effect of a Whole Health Primary Care Pain Education and Opioid Monitoring Program on Implementation of VA/DoD-Recommended Guidelines for Long-term Opioid Therapy in a Primary Care Chronic Pain Population

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2146-2153
Author(s):  
Deanna Marszalek ◽  
Amber Martinson ◽  
Andrew Smith ◽  
William Marchand ◽  
Caroline Sweeney ◽  
...  
Keyword(s):  
Primary Care ◽  
Informed Consent ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Opioid Therapy ◽  
Pain Education ◽  
Prescription Drug Monitoring Program ◽  
Urine Drug ◽  
Recommended Guidelines

Abstract Objective To describe the core elements of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) and examine its effectiveness at increasing adherence to six of the Veteran Affairs/Department of Defense (VA/DoD) recommended guidelines for long-term opioid therapy (LOT) among chronic noncancer patients seen in primary care (i.e., urine drug screens [UDS], prescription drug monitoring program [PDMP] queries, informed consent, naloxone education/prescriptions, morphine equivalent daily dose [MEDD], and referrals to nonpharmacological pain interventions). Design/Methods A within-subjects comparison of outcomes was conducted between pre- and post-PC-POP enrollees (N = 25), as was a a between-subjects comparison to a comparison group (N = 25) utilizing a six-month range post–index date of 10/1/2018 (i.e., between-subjects comparison at Time 2). Subjects A convenience sample of adult veterans with chronic noncancer pain receiving opioid therapy consecutively for the past three months in primary care. Results Results showed increased concordance with VA/DoD guidelines among those enrolled in the PC-POP, characterized by increased documentation of urine drug screens, prescription drug monitoring program queries, informed consent, naloxone education/prescriptions, and a decrease in MEDD among patients enrolled in the PC-POP. Conclusions The PC-POP shows promise for increasing guideline-concordant care for providers working in primary care.

Provider Prescription Drug Monitoring Program Utilization and Self-Auditing—A Pilot Study

2020 ◽  
Vol 13 (2) ◽  
pp. 142-147
Author(s):  
Whitnee C. Brown ◽  
Kelli Whitted
Keyword(s):  
Public Health ◽  
Prescription Drug ◽  
Drug Monitoring ◽  
Healthcare Providers ◽  
Monitoring Program ◽  
Well Being ◽  
Opioid Therapy ◽  
Aggregate Data ◽  
Self Report ◽  
Public Health Officials

BackgroundAlabama has the highest prescription rate in the country. The national incidence of overdose deaths from prescription opioids exceeds the combined death rates from heroin and cocaine overdose. Monitoring prescription access should be an essential activity among providers and can be used to protect patient health and well-being. Prescription drug monitoring programs (PDMPs) are tools that assist in diminishing opioid therapy risks such as diversion, abuse, overdose, and death.ObjectiveThe purpose of the study was to examine the effects of an educational intervention on opioid prescriptive rates, frequency of self-auditing and days of opioid supply among healthcare providers. The anticipated goal of the project was that rates and days of supply for opioid prescriptions would decrease.MethodA pretest–posttest design was used to assess a sample of 21 DEA licensed providers who attended a PDMP presentation and conducted a self-audit using the PDMP.ResultsAnalysis showed that 81% of the participants had never conducted a self-audit prior to the intervention. Self-report data indicated that 85.7% of the providers planned to increase their self-auditing use postintervention and 14.3% planned to make no changes to their current use of the PDMP. Among those who prescribed opioids, the range of monthly prescriptions written was 3–142 preintervention (M = 32.28, SD = 41.04) and 3–149 postintervention (M = 32.26, SD = 43.32). Analysis also found the days of opioid supply prescribed were also high. In both cases, these numbers were correlated to patient census.Implications for NursingThe PDMP is an effective surveillance tool that provides aggregate data to state public health officials. For a PDMP to be effective, it must be used by prescribing providers. While the anticipated goal for this study was not achieved, the PDMP is an effective surveillance tool for monitoring the controlled substance prescription histories of patients. Using the PDMP before prescribing can aid providers in distinguishing those who legitimately have a need from those who may be seeking to misuse the medications. Additionally, use of a PDMP can provide aggregate data to state public health officials so that education programs, for practitioners and patients, can be developed.

scholarly journals Consumer/Patient Encounters with Prescription Drug Monitoring Programs: Evidence from a Medicaid Population

2012 ◽  
Vol 3S;15 (3S;7) ◽  
pp. ES169-ES175
Author(s):  
Amie Goodin
Keyword(s):  
Cancer Pain ◽  
Prescription Drug ◽  
Drug Monitoring ◽  
Claims Data ◽  
Monitoring Program ◽  
Controlled Substances ◽  
Prescription Drug Monitoring Programs ◽  
Medical Need ◽  
Medicaid Population ◽  
Controlled Substance

Background: Prescription drug monitoring programs issue reports about a patient’s controlled substance prescription history upon request to physicians, law enforcement officials, and pharmacists. The dual purposes of these programs are to reduce the abuse and diversion of controlled substances while not preventing access to these medications for legitimate medical need. Objective: The purpose of this study was to examine the experiences of Medicaid patients with Kentucky’s Prescription Drug Monitoring Program (PDMP). Study Design: A random sample of Medicaid patients was surveyed in 2010; respondents were matched with patient retrospective claims data from 6 months prior to the survey’s administration. Study Setting: Kentucky Medicaid patients from across the state. Methods: A combination of patient surveys and Medicaid claims data was used to test the relationship between patient characteristics and patient-reported interactions with physicians regarding their PDMP reports and whether they experienced difficulty obtaining or filling a prescription for a controlled substance due to a PDMP report. Results: Most Medicaid patients are unaffected by the PDMP; however, patients diagnosed with chronic non-cancer pain conditions and patients reporting a Hispanic ethnicity are significantly more likely to have a physician discuss their PDMP report with them. Patients diagnosed with chronic non-cancer pain conditions are also significantly more likely to report difficulty obtaining a prescription for a controlled substance than patients that have not been diagnosed with chronic non-cancer pain conditions. Patients living in rural areas are significantly less likely than patients in urban areas to report difficulty obtaining a prescription for a controlled substance. Limitations: The utilization of controlled substance prescriptions by respondents was not measured or monitored. The Medicaid population examined in this study may not be representative of the population as a whole. Conclusions: These results suggest that more attention to the consumer/patient perspective is warranted in maintaining a balanced approach to decreasing drug abuse and diversion while not limiting access to controlled substances in cases of legitimate medical need Key words: Prescription Drug Monitoring Program, Medicaid, controlled substances, chronic pain patients, patient experiences, KASPER

Trends in Florida's Prescription Drug Monitoring Program registration and utilization: Implications for increasing voluntary use

2017 ◽  
Vol 13 (5) ◽  
pp. 283 ◽  
Author(s):  
Chris Delcher, PhD ◽  
Yanning Wang, MS ◽  
Henry W. Young, MD ◽  
Bruce A. Goldberger, PhD ◽  
Siegfried Schmidt, MD, PhD, FAAFP ◽  
...  
Keyword(s):  
Prescription Drug ◽  
Drug Monitoring ◽  
National Policy ◽  
Monitoring Program ◽  
Meaningful Use ◽  
Utilization Rate ◽  
Cumulative Number ◽  
Policy Goals ◽  
Prescription Drug Monitoring Programs ◽  
Effective Use

Objective: Effective use of state prescription drug monitoring programs (PDMPs) to track controlled substance prescribing and dispensing may help mitigate the current opioid crisis. Our objective was to examine trends in registration for and use of Florida's PDMP by physicians and pharmacists, from 2013 to 2016. We discuss implications for PDMP uptake and policy.Design: Key measures, such as cumulative number of registrants per license type and monthly utilization intensity, are presented. A time series forecasting approach was used to (1) model the monthly count of new PDMP registrants and users from January 2013 to December 2016 and (2) estimate cumulative registration totals after 1 year.Setting: Florida.Results: As of November 2016, there were 16,498 physicians (representing 31 percent of Drug Enforcement Administration licensees) and 17,241 pharmacists registered with the PDMP, representing 21 and 57 percent of professional licensees, respectively. Of note, the PDMP's designation as a “specialized registry” for electronic medical record “meaningful use” criteria led to a nearly sevenfold increase in physician registrations in a single month. In November 2016, pharmacists displayed a higher past-month PDMP utilization rate (52.2 percent vs 30.1 percent), while physicians displayed a higher past-month PDMP utilization intensity (58.1 vs. 36.1 queries per user). Approximately 25,000 physicians and 31,000 pharmacists must register by the end of 2017 to meet national policy goals.Conclusion: PDMP registration among physicians and pharmacists is limited, and the use of the PDMP among registrants is more limited still. Our findings suggest that Florida will not meet national policy goals for registrants by the end of 2017, although new initiatives may alter this trend. Allowing the PDMP to help prescribers meet other professional needs, such as “meaningful use” or similar efforts, may be effective in increasing PDMP use.

Law Enforcement Officers’ Perceptions of Florida’s Prescription Drug Monitoring Program

2017 ◽  
Vol 33 (4) ◽  
pp. 368-379 ◽  
Author(s):  
Nicholas M. Perez ◽  
Wesley G. Jennings ◽  
Yanning Wang ◽  
Chris Delcher
Keyword(s):  
Law Enforcement ◽  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Public Health Problem ◽  
Law Enforcement Officers ◽  
The United States ◽  
Medication Misuse ◽  
Prescription Drug Monitoring Programs ◽  
Effective System

Prescription pain medication misuse and abuse is a considerable criminal justice and public health problem in the United States. As a result, prescription drug monitoring programs (PDMPs) have been developed and implemented across the country to monitor patients with high abuse potential and to detect abnormalities in the prescribing of controlled substances. The current study relies on a sample of 87 Florida law enforcement officers to gauge their perceptions of, use of, and perceived effectiveness of Florida’s PDMP. Results indicate that most of the law enforcement officers considered themselves moderate-to-frequent users of the PDMP and considered the PDMP to be an effective system. In addition, many of the officers reported that their communication had increased with prescribers and pharmacists because of the PDMP. These findings notwithstanding, some officers noted a few barriers/limitations of the PDMP such as “false negatives” and an inability to check another state’s PDMP as areas for improvement. Study limitations and implications are also discussed.

scholarly journals Provider reasons for discontinuing long-term opioid therapy following aberrant urine drug tests differ based on the type of substance identified

2018 ◽  
Vol 14 (4) ◽  
pp. 295-303
Author(s):  
Jessica J. Wyse, PhD ◽  
Benjamin J. Morasco, PhD ◽  
Steven K. Dobscha, MD ◽  
Michael I. Demidenko, BS ◽  
Thomas H. A. Meath, MPH ◽  
...  
Keyword(s):  
Drug Testing ◽  
Prescription Medication ◽  
Opioid Therapy ◽  
Prescription Medications ◽  
Department Of Veterans Affairs ◽  
Urine Drug ◽  
Va Health Care System ◽  
Record Review ◽  
Illicit Substances

Objective: Urine drug testing (UDT) is increasingly performed as a means of identifying aberrant behavior that may be grounds for discontinuation of long-term opioid therapy (LTOT). Little is known, however, about the ways in which positive UDT results may differentially inform decisions to discontinue LTOT based on the type of substance for which the UDT screened positive. The aim of this study was to examine the likelihood of clinician-initiated discontinuation of LTOT attributed to positive UDT results across three discrete categories of substances: (1) cannabis, (2) alcohol or illicit substances (excluding cannabis), and (3) controlled prescription medications that were not prescribed.Design: This retrospective study utilized the US Department of Veterans Affairs (VA) Health Care System. Corporate Data Warehouse to assemble a sample of 600 patients with substance use disorders and matched controls who were discontinued from LTOT in 2012. Comprehensive manual medical record review identified UDT results in the year prior to discontinuation and reason(s) for discontinuation.Patients, Participants: Patients with one or more UDTs positive for a single substance (N = 185) comprised the study sample.Main Outcome Measure(s): Likelihood of clinician-initiated discontinuation attributed to a positive UDT across the three categories. Results: Patients with one or more UDTs positive for cannabis were more likely to be discontinued from opioid therapy as a result of the positive UDT compared to those with one or more UDTs positive for nonprescribed prescription medication (adjusted odds ratio [OR] = 18.05, 95% CI = 7.29-44.66). Similarly, patients with UDTs positive for alcohol or illicit substances were more likely to be discontinued for the positive UDTs relative to patients who tested positive for nonprescribed prescription medications (adjusted OR = 13.10, 95% CI = 4.81-35.68). No difference in UDT-related discontinuation decisions was evident between patients with UDTs positive for alcohol/illicit substances versus cannabis (adjusted OR = 1.47, 95% CI = 0.57-3.77). Conclusions: High odds of UDT-related discontinuation were found in patients who tested positive for cannabis, alcohol, or illicit substances, relative to nonprescribed prescription medications.

scholarly journals Improving the design of California’s prescription drug monitoring program

JAMIA Open ◽  
2019 ◽  
Vol 2 (1) ◽  
pp. 160-172 ◽  
Author(s):  
Mustafa I Hussain ◽  
Ariana M Nelson ◽  
Gregory Polston ◽  
Kai Zheng
Keyword(s):  
Decision Support ◽  
Prescription Drug ◽  
Drug Monitoring ◽  
Information Needs ◽  
Monitoring Program ◽  
Structured Interviews ◽  
Opioid Crisis ◽  
Usability Problems ◽  
Prescription Drug Monitoring Programs ◽  
Controlled Substance

Abstract Objective The US CDC identified prescription drug monitoring programs (PDMPs) as a tool to address the contemporary opioid crisis, but few studies have investigated PDMP usability and effectiveness from the users’ perspective. Even fewer have considered how practices differ across medical domains. In this study, we aimed to address these gaps, soliciting perspectives on PDMPs from providers contending with the opioid crisis: physicians working in emergency departments (EDs) and pain management clinics. We aimed to provide practical design recommendations to improve PDMP workflow integration, as well as controlled substance history retrieval, interpretation, and decision support. Methods We conducted 16 in-depth semi-structured interviews with practicing emergency and pain physicians regarding their procedures, problems, and proposed solutions surrounding their use of CURES, California’s PDMP. We investigated design problems in CURES by combining users’ feedback with our usability inspection, drawing upon an extensive body of design literature. Then, we generated alternatives using design methods. Results We found CURES’s design did not accommodate the unique information needs of different medical domains. Further, clinicians had trouble accessing CURES and retrieving patients’ controlled substance histories, mainly due to usability problems that could be addressed with little technical adjustment. Additionally, CURES rendered patient histories in large, cluttered tables, devoid of overview or context, making interpretation difficult and precarious. Lastly, our interviewees had rarely noticed or used advanced features, such as decision support. Discussion and Conclusion Usability barriers inhibited adoption and effective use. We provide practical recommendations for improving opioid control by way of improving PDMP design, based on interviewees’ suggestions and research-based design principles. Our findings have implications for other disciplines, including surgery and primary care.

Alternatives to Opioid Education and a Prescription Drug Monitoring Program Cumulatively Decreased Outpatient Opioid Prescriptions

Pain Medicine ◽  
2020 ◽  
Author(s):  
Adam Sigal ◽  
Ankit Shah ◽  
Alex Onderdonk ◽  
Traci Deaner ◽  
David Schlappy ◽  
...  
Keyword(s):  
Emergency Department ◽  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Cumulative Effect ◽  
Baseline Period ◽  
Prescribing Patterns ◽  
Prescription Drug Monitoring Programs ◽  
Recommended Guidelines ◽  
The Impact

Abstract Introduction Deaths have increased, and prescription medications are involved in a significant percentage of deaths. Emergency department (ED) changes to managing acute pain and prescription drug monitoring programs (PDMPs) can impact the potential for abuse. Methods We analyzed the impact of a series of quality improvement initiatives on the opioid prescribing habits of emergency department physicians and advanced practice providers. We compared historical prescribing patterns with those after three interventions: 1) the implementation of a PDMP, 2) clinician education on alternatives to opioids (ALTOs), and 3) electronic health record (EHR) process changes. Results There was a 61.8% decrease in the percentage of opioid-eligible ED discharges that received a prescription for an opioid from 19.4% during the baseline period to 7.4% during the final intervention period. Among these discharges, the cumulative effect of the interventions resulted in a 17.3% decrease in the amount of morphine milligram equivalents (MME) prescribed per discharge from a mean of 104.9 MME/discharge during the baseline period to 86.8 MME/discharge. In addition, the average amount of MME prescribed per discharge became aligned with recommended guidelines over the intervention periods. Conclusions Initiating a PDMP and instituting an aggressive ALTO program along with EHR-modified process flows have cumulative benefits in decreasing MME prescribed in an acute ED setting.

Sign in / Sign up

Export Citation Format

Share Document