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

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.

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 Mandatory Review of Prescription Drug Monitoring Program Before Issuance of a Controlled Substance Results in Overall Reduction of Prescriptions Including Opioids and Benzodiazepines

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. 299-304
Author(s):  
Alaa Abd-Elsayed
Keyword(s):  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
The United States ◽  
The State ◽  
Prescribing Patterns ◽  
P Value ◽  
Prescription Drug Monitoring Program ◽  
Before And After ◽  
Controlled Substance

Background: To date, there is limited research on whether the various types of mandatory usage of prescription drug monitoring programs (PDMP) have any effects on prescribing patterns, drug usage, patient care, and drug diversion (8-10). Within the United States (US), there is wide variation in individual states’ requirements for the usage of PDMPs. Objective: The objective of this study was to determine whether mandatory prescriber review of a PDMP prior to each issuance of a controlled substance resulted in a reduction in the total number of controlled substance prescriptions dispensed. Study Design: A retrospective review of the State of Wisconsin’s PDMP controlled substance database from April 2015 to March 2019 was performed. The evaluation compared the number of prescriptions among individual drug classes (opioids, benzodiazepines, stimulants) dispensed throughout the state before and after April 1st, 2017, when implementation of a state law mandating the review of the PDMP during each patient encounter prior to issuing a prescription for a controlled substance took effect. Setting: Research was conducted using Wisconsin’s PDMP controlled substance database from April 2015 to March 2019. During this time, controlled substance policy has come to the forefront of the nation due to issues with an opioid epidemic. Methods: Descriptive analysis was used to express data as n and % for categorical data and average ± standard deviation for numerical data. Before- and after-prescription totals were analyzed using a paired t test and Levene’s test for equality of variances. The P value was considered significant at a level ≤ .05. Limitations: Limitations to this study included its retrospective design, focus on a single US state, and possible unforeseen contributors to cause and effect. Results: Prior to the enforcement of the state’s mandatory PDMP legislation, an average of 844,314 controlled substance prescriptions were written monthly. Following the implementation of the law, the average monthly total prescriptions written within the state decreased to 708,063. This was an average monthly reduction of 136,251 prescriptions written or 16.1%. Statistically significant reductions were also seen in opioid and benzodiazepine subgroups (23.0%, 16.3%). Conclusion: Our study suggests that state-enforced mandatory usage of a PDMP, which records all controlled substance prescriptions filled by a pharmacy such as opioids, benzodiazepines, amphetamines, etc. at every encounter prior to prescribing any controlled substance, can provide for a significant reduction in controlled substance prescriptions, specifically opioids and benzodiazepines. Key words: Prescription drug monitoring program, opioids, mandatory usage, benzodiazepines, Wisconsin

scholarly journals Deterrents to Integrating the Prescription Drug Monitoring Program into the Electronic Health Record

2020 ◽  
Vol 25 (3) ◽  
Author(s):  
Sylvia May ◽  
Chris Baumgartner ◽  
Gary Garrety ◽  
Heidi McLaughlin
Keyword(s):  
Electronic Health Record ◽  
Prescription Drug ◽  
Drug Monitoring ◽  
Inappropriate Prescribing ◽  
Monitoring Program ◽  
Washington State ◽  
Health Record ◽  
Controlled Substances ◽  
Prescription Drug Monitoring Program ◽  
Electronic Health

There are over 700 prescription and illicit opioid-related deaths each year in Washington State. Integrating the Prescription Drug Monitoring Program (PDMP) data into the electronic health record (EHR) allows providers seamless access to patient controlled substances prescription histories, thereby reducing inappropriate prescribing and overdoses. The project overview describes the study focus, investigation of barriers to integrating PDMP data into EHRs across care settings for providers in Washington State who prescribe controlled substances. An online survey tool was developed to inquire about barriers to PDMP integration. The article presents survey results, indicating that 81% of respondents were not integrating PMDP data into the EHR and 52% did not plan on integration. The discussion section considers common barriers that providers identified, such as EHR vendor inability to provide an update, difficulty accessing the PDMP, and prioritization. Cost was the most significant barrier. Discovering barriers to PDMP integration allows stakeholders to address these issues and prevent overprescribing of controlled substances.

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.

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