Prescription Drug Monitoring Programs - PDMP Center of Excellence

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Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 6PDMP effectivenessThe established value of PDMPsBefore embarking on a consideration of PDMP best practices, it should be noted that evidence suggestsPDMPs are effective in improving the prescribing of controlled substances and addressing theprescription drug abuse epidemic (PDMP COE, Briefing on PDMP Effectiveness, 2012). PDMP data areunique and irreplaceable in identifying questionable activity with respect to prescription drugs, such asdoctor and pharmacy shopping, prescription fraud, and problematic prescribing. No other system existsthat can compile all controlled substances prescriptions, regardless of who issued the prescription,which pharmacy dispensed it, or the source of payment. According to surveys of PDMP users and a studyof emergency department doctors, PDMPs are an important tool in making sound clinical decisions whenprescribing or dispensing controlled substances (ASPMP, 2007; Kentucky Cabinet for Health and FamilyServices, 2010; Baehren, 2010). Evaluations of PDMPs generally report good user satisfaction with theutility of PDMP reports (Virginia Department of Health Professions and Virginia State Police, 2004;Lambert, 2006; Rosenblatt, 2007).PDMP data can be used to track emerging trends in legitimate prescribing; to evaluate efforts toimprove prescribing practices, such as provider education initiatives (Fisher et al., 2011a); and to reducedrug abuse and diversion, such as drug abuse prevention programs and drug control policies (Carnevale& Associates and PDMP COE, 2010; PDMP COE, NFF 3.2). PDMPs currently assist in investigations ofdiversion of prescription drugs into illegal use (drug diversion) (PDMP COE, NFF 2.3), medical examinerpractice (PDMP COE, NFF 2.6), drug courts (PDMP COE, NFF 2.4), and direct intervention with andsupervision of doctor shoppers as an alternative to criminal investigation (PDMP COE, NFF 2.1), substanceabuse treatment programs (PDMP COE, NFF 2.2), and epidemiological surveillance and early warningsystems (Carnevale & Associates and PDMP COE, 2010). Although questions have been raised about theeffectiveness of PDMPs (Fornili & Simoni-‐Wastila, 2011), several studies suggest a connection betweenPDMP utilization or particular PDMP practices and positive outcomes related to improving, prescribing,and reducing prescription drug abuse (Pearson et al., 2006; Pradel et al., 2009; Reisman et al., 2009;Wang & Christo, 2009; Paulozzi & Stier, 2010; Fisher et al. 2011b; LeMire et al., 2012; Reifler et al., 2012).Given that PDMPs have already proven their worth in many applications, the question addressed in thiswhite paper is what program characteristics and practices are likely to enable PDMPs to become moreeffective in collecting, analyzing, disseminating, and utilizing their data. See McDonald et al. (2004) foran earlier compilation of PDMP practices and recommendations for research on their effectiveness.
Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 7Conceptualizing effectivenessThe effectiveness of PDMPs can be conceptualized in terms of their impact in ensuring the appropriateuse of prescription-‐controlled substances, reducing their diversion and abuse, and improving healthoutcomes, both at the patient and community levels. This impact is maximized when prescriptionhistory data are, to the extent technologically feasible, complete and accurate; analyzed appropriatelyand expeditiously; made available in a proactive and timely manner; disseminated in ways and formatsthat best serve the purposes of end users; and applied in all relevant domains by all appropriate users.This suggests that PDMPs can be thought of as information systems with inputs, internal operations,outputs, and customers who make use of their products. An effective PDMP will optimize all systemphases, expand its customer base to include all appropriate users, and make sure these customers arewell trained in using the PDMP. Best practices need to be identified for each phase.Considerable preliminary work has already been done in this regard, including in formulating theAlliance of States with Prescription Monitoring Programs’ Prescription Monitoring Program (PMP) ModelAct (ASPMP, 2010), developing and continuously updating the standards for transmission of informationfrom pharmacies to PDMPs (standards developed with ASAP), and identifying characteristics and practicesof the “next generation” of PDMPs (Eadie, 2011, May and an “ideal” PDMP (Perrone & Nelson,2012). Although the rationale for the practices mentioned in these documents in many cases seemsboth logical and plausible, the evidence base supporting them is often experiential and not welldocumented.PDMP effectiveness can also be understood in the context of how PDMPs can best work together and inconcert with other agencies, organizations, and health information technologies. Best practices willlikely include data standardization and sharing among PDMPs and other agencies, as well as cooperativearrangements that maximize the value of PDMP data in their completeness, timeliness, analysis, anddissemination. To increase their effectiveness and impact, PDMPs must be integrated with othersystems, including public health, health information exchanges, electronic health records, electronicprescribing, public safety, drug abuse prevention, and drug control. This will ensure that their data aremade seamlessly available to all those engaged in improving controlled substances prescribing andaddressing the prescription drug abuse epidemic. An important intermediate measure of PDMPeffectiveness is therefore the number and type of interorganizational linkages and information-‐sharingagreements between PDMPs and other agencies. Section IV of this paper covers practices that mayincrease such linkages.
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